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
...Definitions an...
...ASB in patients with indwelling urethra...
...a man with a condom catheter is defined by...
...-UTI3 in patients with indwelling ureth...
...ptoms compatible with CA-UTI inclu...
...with spinal cord injury, increased...
...erized patient, pyuria is NOT diagnostic of CA-b...
...sence, absence or degree of pyuria should...
...ing CA-ASB should NOT be interpreted as...
...ce of pyuria in a symptomatic patient suggests...
...heterized patient, the presence or absenc...
...ning for CA-ASB should NOT be done e...
...clinical situations such as pregnant women. (...
...m "CA-bacteriuria" is used when no distinction is...
Strategies
...Strategi...
...Reduction of Inappropria...
...Limiti...
...elling catheters should be placed only when they a...
...lling urinary catheters should not be...
...utions should develop a list of appropriate...
...should require a physician’s order in the...
Institutions should consider use of portab...
...Discontinuation of...
...ce the risk of CA-bacteriuria (A...
and CA-UTI, (A,...
...-UTI. (A, II)659...
...should consider automatic stop-orders to reduce...
...Strateg...
...Infection Pr...
...itals and long-term-care facilities...
...should include education and training of staff r...
...nstitutions may consider feedback of CA-bacteri...
...fficient to make a recommendation as to...
...Alternatives to...
...ondom catheterizati...
...short-term and ( A ,...
...g-term ( B , II )6...
...Intermittent catheteriza...
...rt-term or ( C , I )659...
...-term ( A , III...
...rm or ( C , III )659...
...-term ( A , III )659...
...Suprapubic catheteriza...
...-bacteriuria and ( B , I )659
...( C , III )659...
...Insertion Techniq...
...ing urethral catheters should be ins...
...Intermittent Catheterizat...
...erile) rather than sterile technique m...
...tutional ( B , I )659...
...ltiple-use catheters may be considered in...
...nstitutional ( C , I...
...ydrophilic catheters are NOT recommen...
...A-UTI. ( B , II )659...
...Antimicrobial-C...
...tients with short-term indwelling urethra...
...Prevention Strategies...
...Closed Cathe...
...r drainage system, with ports in the dis...
...-UTI ( A , III )659...
...ients with short-term indwelling urethral...
...d CA-UTI ( A , III )in patients with long-ter...
...n-specific strategies should be developed to ens...
...d that the drainage bag and connect...
...nnected system (catheter preattached to the...
...eriuria or ( A , I )659...
.... ( A , III )659...
...Prophylaxis...
short- ( A , III )6...
...ong-term ( A , II )659
...alts should NOT be used routinely to...
...dwelling urethral or suprapubic ( A , III )659...
...lts may be considered for the reducti...
...a methenamine salt to reduce CA-UTI, the urin...
...ry products should NOT be used routin...
...En...
...ly meatal cleansing with povidone-iodine so...
...Catheter...
...acteriuria or ( A , I )65...
...A-UTI ( A , II...
Catheter irrigation with antimicrobials may be...
...tion with normal saline should NOT b...
...Antimicrobials in...
...riuria or ( A , I )659...
...I. ( A , I )6...
...Routine Catheter Chan...
...ufficient to make a recommendation...
...Prop...
...the time of catheter placement to...
at the time of catheter removal or ( B , I )...
...cement ( A , III )659...
...Screen...
...hort-term or ( A , II...
...g-term ( A , I )659
...ening and treatment of CA-ASB are NOT rec...
...catheterized patients ( A , II...
...xcept in pregnant women ( A , II...
...nd patients undergoing urologic procedu...
...Screeni...
...treatment of CA-ASB that persists 48 hours afte...
Urine...
...en for culture should be obtained prior to init...
...catheter can be discontinued, a voided midstre...
...elling catheter has been in place fo...
...e culture should be obtained from the f...
...the catheter can be discontinued, a...
...Duration of T...
...patients with CA-UTI who have prompt resoluti...
...14 days is recommended in those with a del...
...day regimen of levofloxacin may be...
...antimicrobial regimen may be consi...
...gure 1. Urinary Catheters