Permanent urethral catheter – a good servant, but bad master: Guidelines for prevention, diagnosis, and treatment of catheter-associated urinary tract infections
Authors:
Vladimír Šámal 1,2; Jan Krhut 3; Roman Zachoval 4; Michaela Matoušková 5; Miloš Bro Ák 1
Authors‘ workplace:
Urologická klinika LF UK a FN Hradec Králové
1; Urologické oddělení, Krajská nemocnice Liberec, a. s.
2; Urologická klinika LF OU a FN Ostrava
3; Urologická klinika FTN a 3. LF UK v Praze
4; Urocentrum Praha, s. r. o.
5
Published in:
Čas. Lék. čes. 2022; 161: 303-308
Category:
Guidelines
Overview
Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, which increase morbidity, mortality, prolong the length of hospitalization and have a significant impact on the cost of treatment.
The most efficient preventive method is removing catheters as soon as possible and avoid unnecessary catheterizations. Treatment of asymptomatic bacteriuria is not recommended. In cases of serious CAUTI, vigorous antibiotic therapy covering multidrug-resistant uropathogens should be initiated.
These recommendations are intended for all medical specialties to improve the care of patients with indwelling catheters in the prevention, diagnosis, and treatment of CAUTI in primary care and subsequent long-term care.
Keywords:
urinary tract infection – dysfunction of lower urinary tract – catheter-associated urinary tract infections – permanent urethral catheter – intermittent catheterization
Sources
- Wyndaele J, Madersbacher H, Kovindha A. Conservative treatment of the neuropathic bladder in spinal cord injured patients. Spinal Cord 2001; 39: 294–300.
- Klevens R, Edwards J, Richards C jr. et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007; 122: 160–166.
- Maki D, Tambyah P. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001; 7: 342–347.
- Hooton T, Bradley S, Cardenas D et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50: 625–663.
- Tenke P, Kovacs B, Bjerklund Johansen TE et al. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 2008; 31 (Suppl. 1): S68–S78.
- Tenke P, Köves B, Johansen T. An update on prevention and treatment of catheter-associated urinary tract infections. Curr Opin Infect Dis 2014; 27: 102–107.
- Lo E, Nicolle L, Coffin S et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35: 464–479.
- Gould C, Umscheid C, Agarwal R et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31: 319–326.
- Chenoweth C. Urinary tract infections: 2021 update. Infect Dis Clin North Am 2021; 35: 857–870.
- National Healthcare Safety Network. Catheter-Associated Urinary Tract Infection (CAUTI) and Non-Catheter-Associated Urinary Tract Infection (UTI) (and Other Urinary System Infection (USI)). NHSN, 2022. Dostupné na: www.cdc.gov/nhsn/psc/uti/index.html
- Johansen T, Botto H, Cek M et al. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system. Int J Antimicrob Agents 2011; 38 (Suppl.): 64–70.
- Tambyah P, Halvorson K, Maki D. A prospective study of pathogenesis of catheter-associated urinary tract infections. Mayo Clin Proc 1999; 74: 131–136.
- Waites K, Canupp K, DeVivo M. Microbiology of the urethra and perineum and its relationship to bacteriuria in community-residing men with spinal cord injury. J Spinal Cord Med 2004; 27: 448–452.
- Warren J, Tenney J, Hoopes J et al. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146: 719–723.
- MacFadden D, Ridgway J, Robicsek A et al. Predictive utility of prior positive urine cultures. Clin Infect Dis 2014; 59: 1265–1271.
- Chuang L, Tambyah P. Catheter-associated urinary tract infection. J Infect Chemother 2021; 27: 1400–1406.
- Ortega M, Marco F, Soriano A et al. Epidemiology and outcome of bacteraemia in neutropenic patients in a single institution from 1991–2012. Epidemiol Infect 2015; 143: 734–740.
- Niël-Weise B, van den Broek P, da Silva E et al. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 2012; 8: CD004201.
- Kumon H. Management of biofilm infections in the urinary tract. World J Surg 2000; 24: 1193–1196.
- Heráček J, Urban M, Sobotka V a kol. Urologické komplikace poranění míchy. Postgraduální medicína 2007; 9: 957–964.
- Saint S, Chenoweth C. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am 2003; 17: 411–432.
- Morris N, Stickler D. Encrustation of indwelling urethral catheters by Proteus mirabilis biofilms growing in human urine. J Hosp Infect 1998; 39: 227–234.
- Moore K, Hunter K, McGinnis R et al. Do catheter washouts extend patency time in long-term indwelling urethral catheters? A randomized controlled trial of acidic washout solution, normal saline washout, or standard care. J Wound Ostomy Continence Nurs 2009; 36: 82–90.
- Kennedy A, Brocklehurst J, Robinson J et al. Assessment of the use of bladder washouts/instillations in patients with long-term indwelling catheters. Br J Urol 1992; 70: 610–615.
- Kyrianová A, Šámal V, Šrám J a kol. Použití proplachového systému SUBY G u pacientů s neurogenní dysfunkcí dolních močových cest a dlouhodobě zavedeným permanentním katétrem. Česká urologie 2017; 21: 65–72.
- Alagiri M, Seidmon E. Percutaneous endoscopic cystostomy for bladder localization and exact placement of a suprapubic tube. J Urol 1998; 159: 963–964.
- Bonkat G, Widmer A, Rieken M et al. Microbial biofilm formation and catheter-associated bacteriuria in patients with suprapubic catheterisation. World J Urol 2013; 31: 565-571.
- Lapides J, Diokno A, Silber S et al. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol 1972; 107: 458–461.
- Wyndaele J. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002; 40(10): 536–541.
- Weld K, Dmochowski R. Effect of bladder management on urological complications in spinal cord injured patients. J Urol 2000; 163: 768–772.
- Umscheid C, Mitchell M, Doshi J et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32: 101–114.
- Armbruster C, Prenovost K, Mobley H et al. How often do clinically diagnosed catheter-associated urinary tract infections in nursing homes meet standardized criteria? J Am Geriatr Soc 2017; 65: 395–401.
- Loeb M, Hunt D, O'Halloran K et al. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med 2008; 23: 816–820.
- Kunin C, McCormack R. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med 1966; 274: 1155–1161.
- Thornton G, Andriole V. Bacteriuria during indwelling catheter drainage. II. Effect of a closed sterile drainage system. Jama 1970; 214: 339–342.
- Wolff G, Grädel E, Buchman B. Indwelling catheter and risk of urinary infection: a clinical investigation with a new closed-drainage system. Urol Res 1976; 4: 15–18.
- Kass E. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians 1956; 69: 56–64.
- Wyndaele J, Brauner A, Geerlings S et al. Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int 2012; 110 (11 Pt. C): E910–E917.
- Geng V, Farrell J, Gea-Sánchez M et al. Catheterization indwelling catheters in adults – urethral and suprapubic. Evidence-based guidelines for best practice in urological health care. European Association of Urology Nurses, 2012. Dostupné na: http://nurses.uroweb.org/guideline/catheterisation-indwelling-catheters-in-adults-urethral-and-suprapubic
- Schumm K, Lam T. Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane review. Neurourol Urodyn 2008; 27: 738–746.
- Johnson J, Kuskowski M, Wilt T. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 2006; 144: 116–126.
- Niël-Weise B, van den Broek P. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev 2005; 3: CD005428.
- Lusardi G, Lipp A, Shaw C. Antibiotic prophylaxis for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev 2013; 7: CD005428.
- Salomon J, Denys P, Merle C et al. Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2-year follow-up – an observational prospective study. J Antimicrob Chemother 2006; 57: 784–788.
- Wazait H, van der Meullen, Patel H et al. Antibiotics on urethral catheter withdrawal: a hit and miss affair. J Hosp Infect 2004; 58: 297–302.
- Jewes L, Gillespie W, Leadbetter A et al. Bacteriuria and bacteraemia in patients with long-term indwelling catheters--a domiciliary study. J Med Microbiol 1988; 26: 61–65.
- Bregenzer T, Frei R, Widmer A et al. Low risk of bacteremia during catheter replacement in patients with long-term urinary catheters. Arch Intern Med 1997; 157: 521–525.
- Romanelli G, Giustina A, Cravarezza P et al. A single dose of aztreonam in the prevention of urinary tract infections in elderly catheterized patients. J Chemother 1990; 2: 178–181.
- Wazait H, Patel H, van der Meulen J et al. A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin. BJU Int 2004; 94: 1048–1050.
- Marschall J, Carpenter C, Fowler S et al. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis. Bmj 2013; 346: f3147.
- Davies A, Desai H, Turton S et al. Does instillation of chlorhexidine into the bladder of catheterized geriatric patients help reduce bacteriuria? J Hosp Infect 1987; 9: 72–75.
- Jepson R, Williams G, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2012; 10: CD001321.
- Burke J, Garibaldi R, Britt M et al. Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens. Am J Med 1981; 70: 655–658.
- Burke J, Jacobson J, Garibaldi R et al. Evaluation of daily meatal care with poly-antibiotic ointment in prevention of urinary catheter-associated bacteriuria. J Urol 1983; 129: 331–334.
- Huth T, Burke J, Larsen R et al. Randomized trial of meatal care with silver sulfadiazine cream for the prevention of catheter-associated bacteriuria. J Infect Dis 1992; 165: 14–18.
- Gillespie W, Simpson R, Jones J et al. Does the addition of disinfectant to urine drainage bags prevent infection in catheterised patients? Lancet 1983; 1: 1037–1039.
- Classen D, Larsen R, Burke J et al. Prevention of catheter-associated bacteriuria: clinical trial of methods to block three known pathways of infection. Am J Infect Control 1991; 19: 136–142.
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