Does the Addition of Disinfectant to Urine Drainage Bags Prevent Infection in Catheterised Patients?

Gillespie, W. A.; Jones, JudithE; Teasdale, C.; Simpson, R.A.; Nashef, Lina; Speller, DavidC.E

doi:10.1016/s0140-6736(83)92657-0

Cited by 89 publications

(23 citation statements)

References 9 publications

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“…34 Likewise, antimicrobial drainage bag solutions and antimicrobial bladder washes achieve only short-term suppression of bacteriuria. [77][78][79][80][81] Daily irrigation of long-term urinary catheters with normal saline also failed to reduce febrile episodes and bacteriuria 82 ; this finding is not surprising because catheter-associated biofilm by definition will not be dislodged by a saline rinse.…”

Section: Ineffective Strategiesmentioning

confidence: 99%

Role of biofilm in catheter-associated urinary tract infection☆

Trautner

Darouiche

2004

American Journal of Infection Control

366

271

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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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Section: Ineffective Strategiesmentioning

confidence: 99%

Role of biofilm in catheter-associated urinary tract infection☆

Trautner

Darouiche

2004

American Journal of Infection Control

366

271

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“…Antibacterial substances added to the catheter drainage bag do not prevent symptomatic infection (118)(119)(120), and daily periurethral care with either soap and water or antiseptics does not decrease infection acquisition in patients with indwelling catheters (121)(122)(123). Future developments in catheter biomaterials to inhibit biofilm formation may limit biofilm-associated infections, but benefits from this approach have not yet been realized for clinical practice (124).…”

Section: Preventionmentioning

confidence: 99%

Complicated Urinary Tract Infection in Adults

Nicolle¹

2005

Canadian Journal of Infectious Diseases and Medical Microbiolog

216

156

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OBJECTIVE: To review current knowledge relevant to complicated urinary tract infection, and to provide evidence-based recommendations for management. METHODS: The literature was reviewed through a PubMed search, and additional articles were identified by journal reference review. A draft guideline was prepared and critically reviewed by members of the Association of Medical Microbiology and Infectious Disease Canada Guidelines Committee, with modifications incorporated following the review. RESULTS: Many urological abnormalities may be associated with complicated urinary infection. There is a wide spectrum of potential infecting organisms, and isolated bacteria tend to be more resistant to antimicrobial therapy. Morbidity and infection outcomes in subjects with complicated urinary infection are principally determined by the underlying abnormality rather than the infection. Principles of management include uniform collection of a urine specimen for culture before antimicrobial therapy, characterization of the underlying genitourinary abnormality, and nontreatment of asymptomatic bacteriuria except before an invasive genitourinary procedure. The antimicrobial regimen is determined by clinical presentation, patient tolerance, renal function and known or anticipated infecting organisms. If the underlying abnormality contributing to the urinary infection cannot be corrected, then early post-treatment recurrence of infection is anticipated. CONCLUSIONS: The management of complicated urinary infection is individualized depending on patient variables and the infecting organism. Further clinical investigations are necessary to assist in determining optimal antimicrobial regimens.

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“…This is often a consequence of the bag being lifted above the level of the bladder, allowing a retrograde flow of urine. Thus, several studies [50][51][52][53][54][55][56] have evaluated the effect of adding various antibacterial agents (eg, chlorhexidine, hydrogen peroxide, and povidone-iodine) to the drainage bag. Several reports [50][51][52][53] suggest this intervention may prevent catheter-related UTI, but some 50,52 were flawed by using a before-andafter design or by using other interventions in addition to the drainage bag antibacterial agents.…”

Section: Antimicrobial Drugs In the Drainage Bagmentioning

confidence: 99%

Preventing Catheter-Related Bacteriuria

1999

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Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. We performed an evidence-based synthesis of the literature on preventing catheter-associated urinary tract infections (UTIs) to develop recommendations for clinicians. Catheterization should be avoided when not required and when needed, should be terminated as soon as possible. Use of suprapubic and condom catheters may be associated with a lower risk of UTI than use of urethral catheters. Aseptic catheter insertion and a properly maintained closed drainage system are crucial to reducing the risk of bacteriuria. Instillation of antimicrobial agents into the bladder or urinary drainage bag and rigorous meatal cleansing seem to be of little benefit. Use of urinary catheters coated with silver alloy may reduce the risk of UTI. Systemic antimicrobial drug therapy seems to prevent UTIs, but primarily for patients catheterized for 3 to 14 days. Antibiotic drug prophylaxis is especially valuable in patients undergoing transurethral resection of the prostate or renal transplantation. Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms.

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Does the Addition of Disinfectant to Urine Drainage Bags Prevent Infection in Catheterised Patients?

Cited by 89 publications

References 9 publications

Role of biofilm in catheter-associated urinary tract infection☆

Role of biofilm in catheter-associated urinary tract infection☆

Complicated Urinary Tract Infection in Adults

Preventing Catheter-Related Bacteriuria

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