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
...initions and Diag...
...ts with indwelling urethral, indwelling su...
...man with a condom catheter is defined b...
...-UTI3 in patients with indwelling urethral, in...
...mptoms compatible with CA-UTI include ne...
...h spinal cord injury, increased spasticity...
...rized patient, pyuria is NOT diagnost...
...presence, absence or degree of pyuria sho...
...ying CA-ASB should NOT be interpreted...
...of pyuria in a symptomatic patient suggests a...
...zed patient, the presence or absence of odorous or...
...creening for CA-ASB should NOT be...
...d in selected clinical situations such as pregn...
...A-bacteriuria" is used when no distinctio...
Strategies
...ategies...
...n of Inappropriate Urinary Catheter...
...iting Unnecessary Catheteriz...
...ng catheters should be placed only when t...
...lling urinary catheters should not be used...
...stitutions should develop a list of appropriate...
...tions should require a physician’s order i...
...ns should consider use of portable...
...iscontinuation of Catheter...
...educe the risk of CA-bacteriuria (A, I)...
...nd CA-UTI, (A, II...
...CA-UTI. (A, II)659...
...titutions should consider automatic stop-o...
...rategies to Consider Prior to Catheter Insertion
...nfection Prevention...
...long-term-care facilities should...
...ies should include education and training of st...
...ons may consider feedback of CA-bacteriuria ra...
...are insufficient to make a recommendation as...
...ternatives to Indwelling Urethral Catheteriza...
...dom catheterization...
...term and ( A , II )659...
...term ( B , II )659...
...ent catheterization...
...rm or ( C , I )659...
long-term ( A , III )6...
...rt-term or ( C , III )6...
...-term ( A , III )6...
...uprapubic catheter...
...A-bacteriuria and ( B ,...
CA-UTI. ( C , II...
...sertion Technique for Indwelling Urethral Catheter...
...g urethral catheters should be inserted u...
...nt Catheterization Technique...
...erile) rather than sterile technique may be consi...
...d institutional ( B , I )65...
...iple-use catheters may be considered instead...
...titutional ( C , I )...
Hydrophilic catheters are NOT reco...
...UTI. ( B , II )659...
...timicrobial-Coated Catheters
...with short-term indwelling urethral cath...
Prevention Strategies to Consider After Ca...
...sed Catheter Sy...
...atheter drainage system, with ports in the dista...
and CA-UTI ( A , III )...
...with short-term indwelling urethral or suprap...
...nd CA-UTI ( A , III )in patients...
...itution-specific strategies should be developed t...
...the drainage bag and connecting tub...
...f a preconnected system (catheter preattache...
...acteriuria or ( A , I...
...A-UTI. ( A , III )6...
...phylaxis...
...ort- ( A , III )659...
...ong-term ( A , II )659...
...ts should NOT be used routinely to reduce CA-bac...
...lling urethral or suprapubic ( A , III )659...
...e salts may be considered for the reduction...
...using a methenamine salt to reduce C...
...ducts should NOT be used routinely to...
...nced Meatal Care...
...eatal cleansing with povidone-iodine soluti...
...atheter Irrigati...
...acteriuria or ( A , I...
...I ( A , II )659...
...igation with antimicrobials may be c...
...irrigation with normal saline should NOT be used...
...bials in the Drainage Bag...
...iuria or ( A , I )659
.... ( A , I )659...
...tine Catheter Cha...
...re insufficient to make a recommenda...
...ylactic Antimicrobials at Time of Cathe...
...of catheter placement to reduce CA-UTI o...
...time of catheter removal or ( B , I...
...nt ( A , III )659...
...reening and Treatment of CA-ASB in Catheter...
...term or ( A , II )6...
...ong-term ( A , I )659
...ning and treatment of CA-ASB are NOT...
...terized patients ( A , III )659...
...pregnant women ( A , III )6...
...ients undergoing urologic procedures for whic...
...creening and Treatment of CA-ASB at Cat...
...icrobial treatment of CA-ASB that persists...
...ulture and Catheter Replacement Before Treatment...
...specimen for culture should be obt...
...r can be discontinued, a voided midst...
...elling catheter has been in place for more t...
...e should be obtained from the fres...
...e catheter can be discontinued, a voided midstre...
Duration of Tre...
...with CA-UTI who have prompt resolution of sy...
...14 days is recommended in those with a delay...
A 5-day regimen of levofloxacin may be conside...
...imicrobial regimen may be considered for women age...
...e 1. Urinary Catheter...