Preventing Catheter-Related Bacteriuria

Abstract

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.

Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients

“…The most important risk factor for catheterassociated urinary tract infection is the duration of catheterization (3,4). Because preventing catheter-related urinary tract infection is difficult (19), an intervention that reduces the duration of unneeded catheterization would be beneficial.…”

Catheter‐associated urinary tract infections: prevalence of uropathogens and pattern of antimicrobial resistance in a UK hospital (1996–2001)

“…Up to 25% of hospitalized patients undergo urinary catheterization [1,2]; a similar proportion of patients cared for in residential homes will have long-term indwelling catheters [3]. Although often a necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infection and have been associated with both morbidity and mortality [1][2][3][4][5][6][7][8][9][10].…”

“…Although often a necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infection and have been associated with both morbidity and mortality [1][2][3][4][5][6][7][8][9][10].…”

“…Up to 30% of catheterized patients can have genitourinary or systemic symptoms related to catheter-associated UTI (CAUTI) [1,8], and up to 4% may develop catheter-related bacteraemia [1,7,11]. Empirical antibiotic treatment is usually started when a symptomatic CAUTI is suspected and the result of urine culture is not yet available.…”

Catheter –Associated Urinary Tract Infection, Management, And Preventions

“…Intermittent and SuprapublicCatheterization.Intermittent catheterization is widely viewed to be associated with fewer complications than indwelling catheterization, including CA-bacteriuria,hydronephrosis,bladderand renal calculi,bladder cancer and autonomic dysreflexia [50].Complications with long-term intermittent catheterization,although apparently less common than with indwelling uretheral catheterization include CAbacteriuria,prostatitis,epididymitis,urethritis,uretheral trauma with bleeding and subsequent uretheral strictures and false passages [50]. Potential advantages of suprapublic catheters in patients who need bladder drainage, compared with indwelling uretheralcatheters,include lower risk of CA-bacteriuria because abdominal skin is less likely to be colonized with uropathogens compared with urethra,reduced risk of uretheral trauma and stricture,less interference with sexual activity and, in those undergoing short-term catheterization,ability to more easily assess the appropriate time for catheter removal [52].…”