Catheter-associated Urinary Tract Infection

Seung Ok Yang

doi:10.14777/kjutii.2013.8.2.73

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Yang: Catheter-associated Urinary Tract Infection

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Korean J Urogenit Tract Infect Inflamm 2013;8(2):73-82.

Published online: 17 October 2013

DOI: https://doi.org/10.14777/kjutii.2013.8.2.73

Catheter-associated Urinary Tract Infection

Seung Ok Yang

Department of Urology, VHS Medical Center, Seoul, Korea

Correspondence to: Seung Ok Yang, Department of Urology, VHS Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 134-791, Korea Tel: +82-2-2225-1493, Fax: +82-2-484-4604 E-mail: seungoc@hanmail.net

No potential conflict of interest relevant to this article was reported.

Received 13 March 2013 Revised 3 April 2013 Accepted 3 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Catheter-associated urinary tract infection (CAUTI) is the most commonly occurring nosocomial infection worldwide, accounting for approximately 40% of all hospital acquired infections. A fair number of hospitalized patients undergo insertion of a urinary catheter at some point during their stay, and the use of indwelling urinary catheters appears to be increasing. Instrumentation of the urinary tract is always a high risk factor for CAUTI. A urinary catheter compromises the normal protective mechanisms of the urinary tract and enables bacterial colonization/biofilm formation on the catheter surface. Bacteriuria may progress toward CAUTI, which has been associated with increased morbidity, mortality, hospital cost, and duration of stay. Unfortunately, many physicians are not aware of appropriate indications for use of indwelling urethral catheters as well as accurate criteria for CAUTI. These conditions could result in superfluous catheterization, a potential source of CAUTI, leading to unnecessary use of antimicrobials for treatment of asymptomatic bacteriuria, resulting in emergence of resistant organisms. We discuss the overall view of CAUTI: definition, pathophysiology, pathogenesis, treatment, and prevention, mainly including descriptions associated with the indwelling urethral catheter.

Keywords: Catheters, Urinary tract infections

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Table 1.

Criteria for symptomatic urinary tract infection proposed by the National Healthcare Safety Network for catheter-associated urinary tractinfection

At least one of the following signs or symptoms with no other recognized cause : fever (>38°C), suprapubic tenderness, costovertebral angle pain or tenderness

or For patient ≤1 year of age, one of fever (>38°C core), hypothermia (<36°C core), apnea, bradycardia, dysuria, lethargy or vomiting and Urine culture with ≥10⁵ CFU/ml with no more than two species of microorganisms

or Urine culture with ≥10³ and <10⁵ CFU/ml with no more than two species and positive urinalysis (one of positive dipstick for leukocyte esterase or nitrite; pyuria [≥10 WBC/mm³ or >5 WBC/HPF unspun urine]; microorganisms in Gram stain of unspun urine)

CFU: colony-forming units, WBC: white blood cells, HPF: high power field.

Table 2.

Appropriate indications for indwelling urethral catheter use identified by the Healthcare Infection Control Practices Advisory Committee

Acute urinary retention or bladder outlet obstruction

Need for accurate measurements of urinary output in critically ill patients

Perioperative use for selected surgical procedures:

- Urologic surgery or other surgery on contiguous structures of the genitourinary tract
- Anticipated prolonged duration of surgery
- Patients anticipated to receive large-volume infusions or diuretics during surgery
- Need for intraoperative monitoring of urinary output

To assist in healing of open sacral or perineal wounds in incontinent patients

Prolonged immobilization (spine injury, multiple traumatic injuries such as pelvic fractures)

To improve comfort for end-of-life care if needed

Table 3.

Summary of recommendations from published guidelines

Recommendation	CDC	EAU	IDSA	HICPAC	SHEA
Limitation of catheter use
Evaluate necessity of catheterization	Y	Y	Y	Y	Y
Review ongoing need for catheter regularly	Y	Y	Y	Y	Y
Evaluate alternative methods of drainage	Y	U	Y	U	Y
Catheter insertion and selection
Use of aseptic technique/sterile equipment	Y	Y	Y	Y	Y
Use of barrier precautions for insertion	Y	U	U	U	Y
Use smallest bore catheter possible	Y	Y	U	U	Y
Use of silver alloy catheters	ND	Y	Y	Y	N
Use of antimicrobial-impregnated catheters	ND	N	Y	Y	N
Use of hydrophilic catheters	ND	ND	N	Y	ND
Catheter maintenance
Maintain closed drainage system	Y	Y	Y	Y	Y
Replace collecting system if break in asepsis occurs	Y	ND	ND	ND	U
Maintain drainage bag below level of bladder	Y	Y	Y	Y	Y
Avoid routine irrigation	Y	Y	Y	Y	Y
Diagnostics and antimicrobials
Avoid routine urine cultures	Y	Y	Y	Y	Y
Avoid use of systemic antimicrobial prophylaxis	ND	Y	Y	Y	Y
Do not treat asymptomatic bacteriuria	ND	Y	Y	ND	Y
General measures
Practice strict hand hygiene	Y	Y	ND	Y	Y
Train all persons in catheter insertion and maintenance	Y	Y	Y	Y	Y
Written protocols for catheter care	ND	Y	Y	Y	Y

CDC: US Centers for Disease Control and Prevention, EAU: European Association of Urology, IDSA: Infectious Diseases Society of America, HICPAC:Healthcare Infection Control Practices Advisory Committee, SHEA: Society for Healthcare Epidemiology of America, Y: recommended, N: not recommended, U: unresolved (vary according to clinical experience and patient factors), ND: not discussed.

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