Analysis of Infection Risk Factors Related to Clean Intermittent Catheterization (CIC)

Clean intermittent catheterization (CIC) refers to the method of periodically inserting a catheter into the bladder through the urethra under clean conditions to allow regular bladder emptying. Numerous studies have shown that long-term use of CIC in patients with neurogenic bladder dysfunction can eliminate the inconvenience of indwelling catheters and significantly reduce the incidence of urinary tract infections (UTIs) and other complications, thereby prolonging survival and improving quality of life. Therefore, CIC has become the widely accepted scientific method of urinary tract management for patients with spinal cord injury (SCI).

Analysis of Infection Factors Related to CIC

1. Etiological (Pathogen) Studies

Under normal conditions, the urinary system is a sterile environment. However, the insertion or indwelling of a catheter may introduce external pathogens. At the same time, the local mechanical defense mechanisms can be compromised, weakening the urethral mucosa’s resistance to pathogens and allowing microorganisms to ascend into the urinary tract and cause infection.

According to the literature, the distribution of pathogens causing infection—ranked from highest to lowest—is Gram-negative bacilli, Gram-positive cocci, and fungi. Among them, *Escherichia coli*, *Candida albicans*, and *Staphylococcus epidermidis* are the primary pathogens responsible for urinary tract infections. Mixed infections involving multiple microorganisms in a single patient are also common. Therefore, during CIC care, in addition to continuous monitoring of bacteriuria, antimicrobial therapy should be selected or adjusted based on laboratory antimicrobial susceptibility testing to avoid frequent changes in the microbial flora.

2. Catheter Size

A catheter that is too large can increase irritation to the urethra or bladder, leading to discomfort and bladder spasms. Conversely, a catheter that is too small is more prone to blockage, resulting in poor drainage and possible urinary obstruction. These factors may contribute to the occurrence of urinary tract infections (UTIs). Therefore, an appropriate catheter size should be selected based on the patient’s specific condition.

3. Catheter Size

A catheter that is too large may increase irritation of the urethra and bladder, leading to discomfort and bladder spasms. Conversely, a catheter that is too small is more likely to become obstructed, resulting in inadequate drainage and potential urinary retention. These factors may contribute to the development of urinary tract infections (UTIs). Therefore, selecting an appropriate catheter size according to the patient’s specific condition is essential.

4. Measurement of Post-Void Residual Urine

Excessive post-void residual urine, which indicates that the bladder is not emptied in a timely manner, is a significant risk factor for urinary tract infections in patients with spinal cord injury (SCI). The timing and frequency of intermittent catheterization should be adjusted according to the residual urine volume to prevent infections caused by prolonged urinary retention in the bladder.

5. Host Immunity

Infections related to CIC are also closely associated with the patient’s own immune defense. Some patients may be elderly, frail, or have compromised immune function, or may suffer from other underlying conditions such as chronic respiratory diseases or diabetes. These patients are more susceptible to bacteriuria during the course of CIC.

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