Impact of Repeat Catheterization on the Risk of Catheter-associated Urinary Tract Infection in Pelvic Fracture Patients

OBJECTIVE: To evaluate whether reinstrumentation after failed Trial of Void further elevates catheter-associated urinary tract infection (CAUTI) risk beyond that associated with prolonged catheterization alone in patients with pelvic fractures. METHODS: A retrospective review was conducted of patients with pelvic fractures and no urethral injury treated at a level 1 trauma center (University Hospital, Newark, NJ) between 2017 and 2024. Variables included demographics, catheter duration, number of replacements, and urine culture results. CAUTI incidence was compared across catheter duration groups (1-4, 5-7, >7 days) and stratified by number of replacements. Patients who were female, did not undergo a voiding trial, or had bladder or urethral injuries were excluded. RESULTS: Of 380 identified patients, 223 met inclusion criteria. Among patients without catheter replacement, UTI incidence did not differ by duration (P = .282). With one replacement, risk increased significantly with duration (P = .048), driven by a 15.4% incidence in the >7-day group. With two replacements, duration strongly correlated with infection (P = .0009), with CAUTI reaching 77.8% in the >7-day group. Overall, UTI risk rose with the number of replacements (P < .0001). CONCLUSION: CAUTI risk in pelvic fracture patients is primarily driven by repeat catheterization rather than duration alone, with a synergistic increase once indwelling time exceeds 7 days. Optimizing Trial of Void timing and minimizing re-instrumentation may reduce infection rates.