Urinary Tract Infections with Antibiotic Resistant Organisms in Catheterized Nursing Home Patients

Abstract

Long-term use of indwelling urinary catheters in nursing home (NH) patients is a potential cause of significant morbidity. We retrospectively studied 10 NH patients with chronic indwelling urinary catheters. Sixty-four percent of all 84 antibiotic courses prescribed were for bacteriuria alone without clinical infection. Seventy percent of 63 antibiotic courses were followed by bacteriuria with organisms resistant to the antibiotic administered. Bacteria isolated from NH patients often displayed greater resistance to specific antibiotics than those isolated from hospitalized patients. Four of the 20 urinary tract infections were associated with bacteremia. Three episodes of bacteremia were with highly-resistant organisms and one was fatal. Use of urinary catheters and inappropriate use of antibiotics in NH patients results in urinary tract colonization and infection with resistant bacteria and is an important cause of morbidity and mortality.

European and Asian guidelines on management and prevention of catheter-associated urinary tract infections

“…The periurethral bacterial flora, surfaces of the catheter system and the persistent, huge reservoir of contaminated urine as well as the skin of the patient are sources for contamination of the hands of medical personnel who may carry the bacteria to other patients [97,99,106,112] (IIb, III). This may be reduced by treating the catheterised urinary tract as an open wound.…”

Catheter-associated urinary tract infections: diagnosis and prophylaxis

“…Although most CAUTIs are asymptomatic [3], rarely extend hospitalization and add only US$ 500-1000 to the direct costs of acute care hospitalization [4], asymptomatic infections often precipitate unnecessary antimicrobial therapy. Although the costs of catheter-associated urinary tract infections are not as high as for example a deep surgical site infection or a nosocomial pneumonia, CAUTIs are a cause for concern as they are a major reservoir of resistant pathogens [5,6]. Numerous studies have documented a high prevalence of resistant pathogens in CAUTI and the association between nosocomial CAUTI and surgical site infections has been made [7].…”

Bacteriuria and bacteraemia in patients with long-term indwelling catheters-a domiciliary study

“…The longer the period of catheterisation, the greater was the incidence of mixed infection by organisms many of which were resistant to several antibiotics. These facts underline the limitations of antibiotics in the management of catheter-associated urinary infection (Bjork et al, 1984;Gillespie, 1986;Kinder, 1987). It was gratifying to find that relatively few patients in our series were receiving antibiotics although many may have received them previously, in hospital or at home.…”

“…Bacteraemia may occur immediately after operation, or it may be provoked by the removal or change of catheter some days later (Slade, 1958;Talbot, 1962;Cafferkey et al, 1980Cafferkey et al, , 1982. Patients with long-term indwelling catheters are usually nursed in geriatric, orthopaedic and medical wards, often have bacteriuria, and sometimes suffer from bacteraemia (Jepsen et al, 1982;Bjork et al, 1984).…”