A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters

Warren, John W.; Tenney, James H.; Hoopes, John M.; Muncie, Herbert L.; Anthony, William C.

doi:10.1093/infdis/146.6.719

Cited by 601 publications

(408 citation statements)

References 10 publications

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“…As mentioned earlier, Morrison and Wenzel (6) found a similar increase in UTIs caused by enterococci. Risk factors for enterococcal UTI have been identified as urinary tract instrumentation or catheterization (6,7,71,72), other genitourinary tract pathology (6,7), and previous use of antibiotics especially cephalosporin (6). One study noted previously showed that an increase in enterococcal UTI paralleled an increase in cephalosporin use in the hospital (6).…”

Section: Epidemiologic Aspects Of Enterococcal Infectionmentioning

confidence: 99%

The epidemiology of enterococci

Chenoweth

Schaberg

1990

Eur. J. Clin. Microbiol. Infect. Dis.

103

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Section: Epidemiologic Aspects Of Enterococcal Infectionmentioning

confidence: 99%

The epidemiology of enterococci

Chenoweth

Schaberg

1990

Eur. J. Clin. Microbiol. Infect. Dis.

103

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“…24 A study of 20 patients who were chronically catheterized found that 98% of 605 consecutive weekly urine specimens contained >10 5 bacteria/mL of urine, and 77% of the urine specimens contained multiple species. 25 Monthly urine cultures for patients with long-term indwelling catheters show that the bacterial flora is constantly shifting and changing, regardless of antibiotic use. 26 …”

mentioning

confidence: 99%

Role of biofilm in catheter-associated urinary tract infection☆

Trautner

Darouiche

2004

American Journal of Infection Control

366

263

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The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a "biofilm." A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized.Health care providers have traditionally envisioned bacteria in their free-floating or planktonic state, and planktonic organisms have been the focus of traditional microbiologic methods of sampling and culture. 1 However, the predominant form of life for the majority of microorganisms in any hydrated biologic system, such as the human body, is a cooperative community termed a "biofilm." 2 A formal definition of biofilm includes 3 components: (1) adherence of the microorganisms, either to a surface or to each other; (2) a change in gene expression resulting in a different phenotype from the planktonic state; and (3) an extracellular matrix composed of host components and secreted bacterial products. 3,4 A functional definition of biofilm also includes the fact that biofilm results in chronic, persistent infections that are difficult to eradicate with antimicrobial therapy. 5 The relevance of biofilm to catheter-associated urinary tract infection (UTI) (CAU-TI) is that a foreign body, such as an indwelling urethral catheter, connecting a normally sterile, hydrated body site to the outside world will inevitably become colonized with microorganisms. 4 Thus, the central character in the story of CAUTI is really the biofilm on the urinary catheter. PATHOGENESIS OF URINARY CATHETER-ASSOCIATED BIOFILMThe pathogenesis of CAUTI is related to the susceptibility of inert catheter material to microbial colonization. On the surface of normal bladder mucosa, binding of bacteria triggers an NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript inflammatory response that results in an influx of neutrophils and sloughing of epithelial cells with bound bacteria. [6][7][8][9] Both processes contribute to clearance of the bacteria from the mucosal surface. In contrast, catheter surfaces have no inherent defense mechani...

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“…8 Furthermore, the relationship between Proteus bacteriuria and urinary catheter encrustation and blockage is well documented. 9,10 Proteus bacteriuria has likewise been documented in persons with SCI, 1,11,12 but not specifically in association with stones.…”

Section: Resultsmentioning

confidence: 99%

Proteus bacteriuria is associated with significant morbidity in spinal cord injury

2006

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Study Design: Retrospective chart review. Objectives: We investigated the morbidity associated with Proteus bacteriuria in a spinal cord injured (SCI) population. Setting: Michael E DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. Methods: We reviewed the medical records of all veterans with SCI who received care in our medical center during the past 3 years. Proteus bacteriuria was defined as the growth of Proteus species in any urine culture during the study period. Urinary stones were defined as either renal or bladder calculi. Results: During the study period, 71 of the 501 subjects (14%) had Proteus and 90 (18%) had urinary stones. Twenty-seven percent of the subjects with Proteus had stones, and the association of Proteus with stones was significant (Po0.05). Proteus bacteriuria was likewise associated with complete injury, hospitalization, decubitus ulcers, and history of stones (Po0.001). Subjects using indwelling catheters, either transurethral or suprapubic, were significantly more likely to have Proteus, whereas subjects practising spontaneous voiding and clean intermittent catheterization were significantly less likely to have Proteus. In the 90 patients with stones, Proteus was associated with requiring treatment for stones and having multiple stones (Po0.01). Twenty-five of the 90 patients with stones (28%) required treatment, most often with lithotripsy, and 6 (7%) developed urosepsis. Conclusions: In persons with SCI, Proteus was found in subjects with a greater degree of impairment who were more likely to be hospitalized, to have decubiti, and to use indwelling catheters. Bacteriuria with Proteus predicted urologic complications in persons with SCI. Statement of Ethics: All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters

Cited by 601 publications

References 10 publications

The epidemiology of enterococci

The epidemiology of enterococci

Role of biofilm in catheter-associated urinary tract infection☆

Proteus bacteriuria is associated with significant morbidity in spinal cord injury

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