Comparison of Urinary Tract Infection in Elderly Hip Fracture Patients in a Secondary Care Hospital: Early versus Delayed Insertion of Urinary Catheters

Background: The elderly population is growing, leading to a rise in hip fractures and associated complications like urinary tract infection (UTI). Limited resources in hospitals can delay surgery for hip fractures, with an increasing risk of UTI. Early urinary catheter insertion from the first day of admission may increase the risk of UTI due to prolonged catheterization but delayed urinary catheter insertion can also increase the risk of UTI due to urinary retention. Objective: To compare UTI in elderly hip fracture patients in a secondary care hospital between early and delayed urinary catheterization. Materials and Methods: The present study was a retrospective chart review that included hip fracture patients aged 60 years old and older. Data was collected between January 1, 2018, and December 31, 2022. One hundred ninety-nine patients met the inclusion criteria, with 70 patients in early urinary catheterization group and 129 patients in delayed urinary catheterization group. The comparison focused on UTI between the two groups, with additional analyses of length of hospital stay (LOS) and mortality. Results: UTI in early urinary catheter insertion group was 22.9% and UTI in delayed urinary catheter insertion was 10.9%, which was significantly different (p=0.024). The LOS and mortality between the two groups were not significantly different. However, after adjusting for urinary catheter duration in a multivariate regression analysis, the difference in UTI was no longer statistically significant, while LOS was significantly longer in the early urinary catheterization group. Conclusion: Early urinary catheterization was initially associated with a higher UTI, but this difference was no longer significant after adjusting for duration of catheter insertion. This suggests that the increased UTI risk observed in the early urinary catheterization group was due to prolonged urinary catheter use. However, early urinary catheterization remained associated with a significantly longer hospital stay, due to extended duration of urinary catheter insertion. These findings highlight the importance of delaying catheter insertion when possible and minimizing duration of urinary catheter insertion to reduce UTI risk and shorten hospitalization in elderly hip fracture patients.