Catheter-associated urinary tract infections in intensive care units.
The purpose of this review is to analyze literature concerning the diagnosis, prevention, and management of catheter-associated urinary tract infection (CAUTI) occurring in patients hospitalized in the intensive care unit (ICU). Analysis was performed from personal and "Pubmed" data, crossing the following keywords: "urinary tract infection", "catheter', and "intensive care unit". Few clinical trials including ICU patients were found despite the abundance of expert opinions. There is no consensus on the use of urinary reagent tests for diagnosis. The prevention of CAUTI in ICU patients does not require expensive devices. Neither complex closed drainage systems nor silver-coated urinary catheters have demonstrated efficacy in comparative randomized clinical trials. Bladder irrigation should not be used, except when an obstruction of the catheter is highly likely. The administration of prophylactic antimicrobial therapy, although effective in reducing the incidence of urinary bacteria, cannot be recommended in ICU patients. The management of CAUTI in ICU patients has not been evaluated in clinical trials. The level of evidence provided in this field is weak, and underlines the need for randomized studies to improve management of patients.
Leone
Marc
M
Department of Anesthesiology and Intensive Care Medicine, CHU Nord, AP-HM, Marseilles Hospital University System, Chemin des Bourrelys, 13915 Marseille cedex 20, France. mleone@mail.ap-hm.fr
Garnier
Franck
F
Avidan
Michael
M
Martin
Claude
C
D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000379:methods; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control