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 and Diagnosis
...nts with indwelling urethral, indwelling su...
...ASB in a man with a condom catheter...
CA-UTI3 in patients with indwelling urethral, i...
...mptoms compatible with CA-UTI include...
In patients with spinal cord injury, increased s...
...the catheterized patient, pyuria is NOT dia...
...presence, absence or degree of pyuria should NO...
...mpanying CA-ASB should NOT be interpreted...
...absence of pyuria in a symptomatic pat...
...theterized patient, the presence or absence...
...ing for CA-ASB should NOT be done e...
...cted clinical situations such as pregnant women. (...
..."CA-bacteriuria" is used when no distinctio...
Strategies
...trategies
...tion of Inappropriate Urinary Catheter Ins...
...miting Unnecessary Catheterizat...
...heters should be placed only when they...
...ndwelling urinary catheters should not...
...utions should develop a list of appropr...
...titutions should require a physician’s...
...itutions should consider use of port...
...nuation of Catheter...
...reduce the risk of CA-bacteriuria (A,...
and CA-UTI, (A, II)6...
...d CA-UTI. (A, II)...
...s should consider automatic stop-orders to reduc...
...onsider Prior to Catheter Insertio...
...fection Prevention
...tals and long-term-care facilities should develo...
...uld include education and training...
...tutions may consider feedback of CA-bacteriuria r...
...ta are insufficient to make a recom...
...tives to Indwelling Urethral Catheterization...
...dom catheterization...
...hort-term and ( A , II )659...
...ng-term ( B , II...
...mittent catheterization
...hort-term or ( C , I )6...
...-term ( A , III )6...
...rm or ( C , III )659...
long-term ( A , III )659
...apubic catheterizati...
...cteriuria and ( B , I )659
...UTI. ( C , III )659
...hnique for Indwelling Urethral Catheter...
...hral catheters should be inserted u...
...Catheterization Technique...
...n-sterile) rather than sterile technique ma...
...nstitutional ( B , I )659...
Multiple-use catheters may be considered inste...
...institutional ( C , I )...
...ophilic catheters are NOT recommended f...
...A-UTI. ( B , II )...
...ntimicrobial-Coated C...
...nts with short-term indwelling urethral...
...ategies to Consider After Catheter Inserti...
...Catheter System...
...osed catheter drainage system, with ports in...
...A-UTI ( A , III )...
...with short-term indwelling urethral...
...( A , III )in patients with long-term indwelling...
...n-specific strategies should be developed to...
...the drainage bag and connecting tube are alwa...
...preconnected system (catheter preatta...
...acteriuria or ( A , I )659...
...A-UTI. ( A , III )659...
...phylaxis
short- ( A , III...
...-term ( A , II )659...
...henamine salts should NOT be used routinely...
...welling urethral or suprapubic ( A , III )659...
Methenamine salts may be considered...
...methenamine salt to reduce CA-UTI, the...
...products should NOT be used routinely to...
Enhanced Meatal...
Daily meatal cleansing with povidone-iodine...
...atheter Irrigat...
...iuria or ( A , I )659...
...TI ( A , II )65...
...tion with antimicrobials may be considered...
...heter irrigation with normal saline should NOT...
...ials in the Drainage Bag...
...-bacteriuria or ( A , I...
...-UTI. ( A , I )...
Routine Catheter C...
...a are insufficient to make a recommendation as to...
...Antimicrobials at Time of Catheter Remova...
...e time of catheter placement to red...
at the time of catheter removal or ( B ,...
...ment ( A , III )659...
...Treatment of CA-ASB in Catheterize...
...m or ( A , II )659...
...g-term ( A , I )659...
...g and treatment of CA-ASB are NOT recommended...
...erized patients ( A , III )659...
...in pregnant women ( A , III )659...
...nd patients undergoing urologic procedure...
...eatment of CA-ASB at Catheter Removal to Redu...
...ial treatment of CA-ASB that persists 48 hours aft...
...rine Culture and Catheter Replacement Before Tre...
A urine specimen for culture should be obtained p...
...f the catheter can be discontinued, a voided mid...
...welling catheter has been in place for...
The urine culture should be obtained from the f...
...catheter can be discontinued, a voided midstream...
...tion of Treatm...
for patients with CA-UTI who have...
...ys is recommended in those with a delayed respo...
...-day regimen of levofloxacin may be con...
...antimicrobial regimen may be considered for...
...1. Urinary Catheter...