Preventing catheter-related bacteriuria: should we? Can we? How?
Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. We performed an evidence-based synthesis of the literature on preventing catheter-associated urinary tract infections (UTIs) to develop recommendations for clinicians. Catheterization should be avoided when not required and when needed, should be terminated as soon as possible. Use of suprapubic and condom catheters may be associated with a lower risk of UTI than use of urethral catheters. Aseptic catheter insertion and a properly maintained closed drainage system are crucial to reducing the risk of bacteriuria. Instillation of antimicrobial agents into the bladder or urinary drainage bag and rigorous meatal cleansing seem to be of little benefit. Use of urinary catheters coated with silver alloy may reduce the risk of UTI. Systemic antimicrobial drug therapy seems to prevent UTIs, but primarily for patients catheterized for 3 to 14 days. Antibiotic drug prophylaxis is especially valuable in patients undergoing transurethral resection of the prostate or renal transplantation. Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms.
Saint
S
S
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA. saint@umich.edu
Lipsky
B A
BA
D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001437:Bacteriuria / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D006626:Hippurates / Q000627:therapeutic use; D006801:Humans; D008709:Methenamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data
D000892:Anti-Infective Agents, Urinary; D006626:Hippurates; D008709:Methenamine; C011481:methenamine hippurate