catheter-associated urinary tract infection (CAUTI)
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Introduction
Definition:
- indwelling urinary catheter
- sign/symptoms of urinary tract infection
- no other identified source of infection
- >= 1000 colony-forming units/mL of 1 or more bacterial species in a single specimen[3][4]
Etiology
risk factors
- female sex
- age > 50 years
- severe underlying disease
- non-surgical disease
- diabetes mellitus
- serum creatinine > 2.0 mg/dL at the time of catheterization
- prolonged duration of catheterization
- lack of appropriate catheter care
- catheterization after day 6 of hospitalization
- catheter insertion placed outside of the operating room
Epidemiology
- rate of bacteriuria is 3-10%/day while catheter is in place
- by 30 days, virtually all catheterized patients become bacteriuric
- most common type of nosocomial infection
- overall incidence of symptomatic UTI in short-term catherization is 10-30%
- anticipate 1 febrile episode/100 days of catherization
- catheter-related infection with condom catheters is less than that for indwelling urinary catheters only when there is no unnecessary manipulation of the catheter[2]
- 65-70% of catheter-related infections may be preventable[3]
Pathology
- bacteria usually gain access to the urinary tract through periurethral colonization & subsequent migration between the catheter & the uroepithelium
- less commonly, bacteria are introduced via:
- breakdowns in the closed collection system
- the catheterization procedure itself
- colonization of the lumen of the catheter & migration against urinary flow
- urease-producing organisms, i.e. Proteus mirabilis alkalinize urine & may lead to stone formation & obstruction
Laboratory
Management
- assess continued need for catheter every day[12]
- remove catheter in cases of symptomatic infection
- replace catheter only if needed
- asymptomatic bacteriuria does not need treatment[3]
- do not treate asymptomatic candiduria[3]
- treat symptomatic infection after removal or change of catheter[3]
- empiric therapy for suspected symptomatic infection should cover possible polymicrobial flora
- duration not established, but 5-7 days recommended[3]
- adjust antibiotic coverage per antimicrobial sensitivity
- chronic catheter-associated urosepsis
- combination therapy (IV)
- ampicillin 1-2 g every 6 hours, plus
- quinolone, aminoglycoside, or aztreonam
- combination therapy (IV)
- prevention:
- avoid using urinary catheters
- use condom catheter or intermittent catheterization when possble
- adhere to proper hand hygiene
- use sterile technique when inserting the catheter
- use smaller catheters to decrease urethral trauma
- antiseptic coated catheters not effective[3]
- keep urine collecting bag below the level of the bladder[3]
- maintain unobstructed urine flow
- early removal of catheter when feasible
- routine changing of catheter is not necessary or effective[3]
- a national quality-improvement program reduced catheter- associated urinary tract infections in U.S. hospitals[9]
- audit of catheter orders with feedback[11]
Notes
More general terms
Additional terms
References
- ↑ Norman D, UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 Hirsh DD et al Do condom catheter collecting systems cause urinary tract infection? JAMA 242:340, 1979 PMID: https://www.ncbi.nlm.nih.gov/pubmed/448937
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 4.2 Hooton TM, Bradley SF, Cardenas DD 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 Mar 1;50(5):625-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20175247 corresponding NGC guideline withdrawn Feb 2016
- ↑ Yokoe DS et al Introduction to "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates. Infection Control and Hospital Epidemiology. May 2014. 35(5)
- ↑ Centers for Disease Control and Prevention (CDC) Catheter-associated Urinary Tract Infections (CAUTI) http://www.cdc.gov/HAI/ca_uti/uti.html
- ↑ Brusch JL, Bronze MS Medscape: Catheter-Related Urinary Tract Infection http://emedicine.medscape.com/article/2040035-overview
- ↑ Chenoweth CE, Gould CV, Saint S. Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin North Am. 2014 Mar;28(1):105-19. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24484578
- ↑ 9.0 9.1 Saint S, Greene MT, Krein SL et al A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. N Engl J Med 2016; 374:2111-2119. June 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27248619 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1504906
Huang SS Catheter-Associated Urinary Tract Infections - Turning the Tide. N Engl J Med 2016; 374:2168-2169. June 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27248624 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1604647 - ↑ Lo E, Nicolle LE, Coffin SE et al Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S32-47. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25376068
Nicolle LE. Catheter-related urinary tract infection: practical management in the elderly. Drugs Aging. 2014 Jan;31(1):1-10. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24288197 - ↑ 11.0 11.1 11.2 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ 12.0 12.1 NEJM Knowledge+
Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf. 2014 Apr;23(4):277-89. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24077850 PMCID: PMC3960353 Free PMC article. Review.
Clarke K, Hall CL, Wiley Z, Tejedor SC, Kim JS, Reif L, Witt L, Jacob JT. Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. J Hosp Med. 2020 Sep;15(9):552-556. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/31532742 Review. - ↑ <Internet> http://www.catheterout.org