Catheter-Associated Bacteriuria
Key Points
Key Points
Many episodes of CA-bacteriuria are preventable.
The most effective way to reduce CA-ASB and CA-UTI is to reduce urinary catheterization by restricting use to patients who have clear indications and by removing the catheter as soon as it is no longer needed.
Table 1. Acceptable Indications for Indwelling Urinary Catheter Use
| Clinically significant urinary retention |
| Temporary relief or longer term drainage if medical therapy is not effective and surgical correction is not indicated. |
| Urinary incontinence |
| For comfort in a terminally ill patient. |
| If less invasive measures (behavioral and pharmacological interventions, incontinence pads) fail and external collecting devices are not an acceptable alternative. |
| Accurate urine output monitoring required |
| Frequent or urgent monitoring needed, such as critically ill patients. |
| Patient unable or unwilling to collect urine |
| During prolonged surgical procedures with general or spinal anesthesia. |
| Selected urological and gynecological procedures in the perioperative period. |
Definitions and Diagnosis
...ions and Diagnosis...
...patients with indwelling urethral...
...in a man with a condom catheter is d...
...A-UTI3 in patients with indwelling urethral, in...
...oms compatible with CA-UTI include n...
In patients with spinal cord injury, in...
...ized patient, pyuria is NOT diagnostic...
...ence, absence or degree of pyuria should NOT b...
...ia accompanying CA-ASB should NOT be interp...
...ce of pyuria in a symptomatic patient suggests...
...rized patient, the presence or absence o...
...ening for CA-ASB should NOT be done exc...
...elected clinical situations such as preg...
...A-bacteriuria" is used when no distinc...
Strategies
Strategi...
...tion of Inappropriate Urinary Cath...
...ecessary Catheterization...
...catheters should be placed only when they are ind...
Indwelling urinary catheters should not be used...
...should develop a list of appropriate...
...titutions should require a physicia...
...ould consider use of portable bladder sca...
...continuation of Ca...
...o reduce the risk of CA-bacteriuria...
...CA-UTI, (A, II)659...
...-UTI. (A, II)65...
...nstitutions should consider automat...
...s to Consider Prior to Catheter Inserti...
...ction Prevention...
...ospitals and long-term-care facilities...
...ld include education and training of s...
...utions may consider feedback of CA-...
...fficient to make a recommendation as to...
...tives to Indwelling Urethral Catheterization...
Condom catheteriza...
...hort-term and ( A , II )65...
...ong-term ( B , II )659
...tent catheterization...
short-term or ( C ,...
...ong-term ( A , III )...
short-term or ( C , II...
...term ( A , III )659
...ubic catheterization
...uria and ( B , I )659...
...( C , III )659...
...Technique for Indwelling Urethral Catheter...
...ral catheters should be inserted u...
...nt Catheterization Technique...
...le) rather than sterile technique may be...
...institutional ( B , I )...
...tiple-use catheters may be consider...
...institutional ( C ,...
...catheters are NOT recommended for...
...A-UTI. ( B , II )659...
...bial-Coated Catheters...
...th short-term indwelling urethral catheterization,...
...rategies to Consider After Catheter Insertion...
...d Catheter Syste...
...er drainage system, with ports in the distal cat...
...CA-UTI ( A , III )6...
...ents with short-term indwelling ureth...
...A-UTI ( A , III )in patients with long-term ind...
...pecific strategies should be developed to ensure t...
...e drainage bag and connecting tube are always kep...
...of a preconnected system (catheter preattached to...
...-bacteriuria or ( A , I )659...
CA-UTI. ( A , II...
...phylaxis...
...ort- ( A , III...
...-term ( A , II )65...
...mine salts should NOT be used routinely t...
...c indwelling urethral or suprapubic...
...salts may be considered for the reduction of CA-...
...methenamine salt to reduce CA-UTI, the urinary...
...oducts should NOT be used routinely to r...
...nced Meatal Car...
...tal cleansing with povidone-iodine solution,...
Catheter Irrigat...
...-bacteriuria or ( A , I )659...
CA-UTI ( A , II )...
...igation with antimicrobials may be consider...
...ion with normal saline should NOT be used r...
...crobials in the Drainage Bag...
...-bacteriuria or ( A , I...
...UTI. ( A , I )6...
...utine Catheter Change
...icient to make a recommendation as to whether...
...ic Antimicrobials at Time of Catheter Rem...
...of catheter placement to reduce CA-UTI or...
at the time of catheter removal or ( B , I )659
...ent ( A , III )659...
...Treatment of CA-ASB in Catheterized Patients t...
...t-term or ( A , II )659...
long-term ( A , I )6...
...ing and treatment of CA-ASB are NOT recommended...
in other catheterized patients ( A , III )...
...xcept in pregnant women ( A , III )659...
...patients undergoing urologic procedures for which...
...Treatment of CA-ASB at Catheter Remo...
...ntimicrobial treatment of CA-ASB that persists...
...and Catheter Replacement Before Treatment...
...men for culture should be obtained pri...
...f the catheter can be discontinued,...
...an indwelling catheter has been in plac...
...ne culture should be obtained from the freshl...
...heter can be discontinued, a voided...
...on of Treatment...
...ith CA-UTI who have prompt resolutio...
...days is recommended in those with a delayed respo...
...n of levofloxacin may be considered in patients wi...
...icrobial regimen may be considered for women...
...1. Urinary Catheters...