Catheter-Associated Urinary Tract Infection

Definition, Etiology, PathogenesisTop

A single catheterization of the bladder is associated with a 1% to 3% risk of developing bacteriuria. The risk increases by 3% to 10% with every additional day the catheter remains in the bladder; after 30 days of continuous catheterization, the incidence of bacteriuria is almost 100%. Intestinal bacilli are the pathogens most commonly isolated from urine samples, but colonizations by Pseudomonas spp, Enterococcus spp, Staphylococcus spp, and fungi are also frequent. Since symptomatic urinary tract infection (UTI) is rare in patients with an indwelling urinary catheter and bacteriuria, it is not recommended to diagnose and treat asymptomatic bacteriuria in catheterized patients, as the resolution of bacteriuria is transient and followed by rapid selection of drug-resistant microorganisms. Usually, bacteriuria resolves spontaneously once the catheter has been removed; only <1% of patients develop symptomatic UTI. The most common signs and symptoms of UTI include fever, deterioration of the patient’s general condition, leukocytosis, bacteriuria >105 colony-forming units (CFU)/mL (frequently more than one pathogen is identified).

TreatmentTop

On the basis of urine culture results, use an antibiotic with as narrow an antibacterial spectrum as possible for 7 to 14 days, depending on clinical resolution.

PreventionTop

The use of hydrophilic catheters can reduce the frequency of infections. Expanded periurethral cleansing may be helpful in patients in a coma receiving short-term catetherization for up to 10 days.

Antibiotic prophylaxis in patients using clean intermittent self-catheterization may be beneficial in terms of reducing UTI recurrence rates in the short term; however, the emergence of antimicrobial resistance may preclude longer-term management using this approach and is therefore generally not recommended.Evidence 1Weak recommendation (benefits likely outweigh downsides, but the balance is close or uncertain; an alternative course of action may be better for some patients). Low Quality of Evidence (low confidence that we know true effects of the intervention). Quality of Evidence lowered due to lack of blinding and data from a single randomized controlled trial. Xingsong Qin, He Zhao, Wei Qin, et al. Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial. Crit Care. 2024 May 13;28(1):162. doi: 10.1186/s13054-024-04947-7. PMID: 38741134; PMCID: PMC11092077.