A prospective study on the pathogenesis of catheter-associated bacteriuria in critically ill patients

Abstract

Background Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CA-bacteriuria in ICU patients was endoluminal or exoluminal. In a prospective study, quantitative urine cultures were sampled from catheter sampling sites, collector bags and the catheter outer surface near the meatus from days 1 to 15 after catheterization. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and then in catheters. The exoluminal pathway was CA-bacteriuria first in catheters, on day 1 in early cases and after day 1 in late cases. Results Of 64 included patients, 20 had CA-bacteriuria. Means of catheterization days and incidence density were 6.81 days and 55.2/1000 catheter-days. Of 26 microorganisms identified, 12 (46.2%) were Gram positive cocci, 8 (30.8%) Gram negative bacilli and 6 yeasts. Three (11.5%) CA-bacteriuria were endoluminal and 23 (88.5%) exoluminal, of which 10 (38.5%) were early and 13 (50%) late. Molecular comparison confirmed culture findings. A quality audit showed good compliance with guidelines. Conclusion The exoluminal pathway of CA-bacteriuria in ICU patients predominated and surprisingly occurred early despite good implementation of guidelines. This finding should be considered in guidelines for prevention of CA-bacteriuria.

Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

“…This practice is misguided given that pyuria and bacteriuria are frequently present in patients with urinary catheters in the absence of clinical infection. 23 No cut-offs for the degree of leukocytosis or fever have even been found to correlate with UTI. 24 Urinary workup in the absence of appropriate concern for UTI is both costly and leads to unnecessary antibiotics.…”

Emerging evidence-based innovative approaches to control catheter-associated urinary tract infection: a review

“…The pathogenesis of CAUTI begins with the entry of bacterial pathogens, followed by endoluminal or extraluminal colonization of the urinary catheter, leading to biofilm formation ( Aumeran et al., 2021 ). Meanwhile, host defense strategies clear pathogens during voiding or intrinsic antibacterial action under normal conditions owing to the glycosaminoglycan coating on the urothelial cells (D. Zhang et al., 2004 ).…”

In vitro and in vivo study of antibacterial and anti‐encrustation coating on ureteric stents

“…Bacterial colonisation rate on scaffolds can reach 65% and 80% after implantation for 2–3 and 3–4 months, respectively [6,7]. Bacteria can ascend along a ureteric stent and enter the kidneys from the bladder, resulting in high rates of contamination and bacteriuria [8]. Bacteraemia due to catheter‐associated bacteriuria is responsible for as high as 13% of deaths [9].…”