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...
...atients with indwelling urethral, i...
...in a man with a condom catheter is defined by...
...nts with indwelling urethral, indwelling supr...
...ms compatible with CA-UTI include new onset o...
...h spinal cord injury, increased spasticity...
...zed patient, pyuria is NOT diagnostic of CA-bacter...
...resence, absence or degree of pyuria...
...companying CA-ASB should NOT be interpr...
...he absence of pyuria in a symptomatic...
...theterized patient, the presence or absence o...
...or CA-ASB should NOT be done excep...
...cted clinical situations such as pr...
...teriuria" is used when no distinction is mad...
Strategies
...Strategi...
...Reduction of Inapp...
...Limiting Unnecess...
...catheters should be placed only when they ar...
...welling urinary catheters should n...
...tions should develop a list of appro...
...ould require a physician’s order in the ch...
...tutions should consider use of portable bl...
...Discontinuat...
To reduce the risk of CA-bacteri...
...A-UTI, (A, II)659...
...CA-UTI. (A, II)659...
...tions should consider automatic sto...
...Strategies to C...
...Infection Prevention...
...ong-term-care facilities should develop, maint...
...d include education and training of staff releva...
Institutions may consider feedback of CA-bact...
...insufficient to make a recommendation...
...Alternatives...
...catheterization
...-term and ( A , II )659...
...ong-term ( B , II...
...Intermittent cathe...
...rt-term or ( C , I )...
...term ( A , III )65...
...-term or ( C , III )6...
...term ( A , III )659...
...Suprapubic catheterizat...
...cteriuria and ( B , I )...
...-UTI. ( C , III...
...lling urethral catheters should be inse...
...Interm...
...(non-sterile) rather than sterile technique may...
...tutional ( B , I )659
Multiple-use catheters may be consider...
...tutional ( C , I )659...
...eters are NOT recommended for routine use t...
...r CA-UTI. ( B , II...
...Antimicr...
...patients with short-term indwelling urethral c...
...Prevention Strategies...
...Closed Ca...
...d catheter drainage system, with ports in...
...TI ( A , III )659...
...nts with short-term indwelling urethral...
...III )in patients with long-term indwellin...
...cific strategies should be developed...
...that the drainage bag and connect...
Use of a preconnected system (catheter p...
...iuria or ( A , I )659...
...A-UTI. ( A , II...
...Prophylaxis...
...- ( A , III )659...
...r long-term ( A , II )659
...e salts should NOT be used routinely to redu...
...c indwelling urethral or suprapubic ( A , II...
...ethenamine salts may be considered for t...
...n using a methenamine salt to reduce CA-...
...rry products should NOT be used routinely to re...
...Enha...
...eansing with povidone-iodine solut...
...Catheter Irrigation...
...teriuria or ( A , I )659...
...( A , II )65...
...irrigation with antimicrobials may be considered i...
...igation with normal saline should NOT be...
...Antimicrobi...
...iuria or ( A , I )659...
...TI. ( A , I )659...
...Routine Catheter...
...are insufficient to make a recommendation a...
...e of catheter placement to reduce CA-U...
...me of catheter removal or ( B , I )...
...acement ( A , III )659
...Screening and...
...rt-term or ( A , II )...
...term ( A , I )659...
...reatment of CA-ASB are NOT recommended to redu...
...heterized patients ( A , III )659...
...ept in pregnant women ( A , III )6...
...tients undergoing urologic procedu...
...Screeni...
Antimicrobial treatment of CA-ASB that persist...
...Urine...
...pecimen for culture should be obtained...
...f the catheter can be discontinued, a voided mid...
...welling catheter has been in place for...
...urine culture should be obtained from the freshl...
...ter can be discontinued, a voided midstream ur...
...Durati...
...s with CA-UTI who have prompt resoluti...
...14 days is recommended in those with a delayed r...
...ay regimen of levofloxacin may be co...
...ntimicrobial regimen may be consid...
...1. Urinary Cathete...