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
...itions and Diagnosis
...in patients with indwelling urethral,...
...n a man with a condom catheter is def...
...in patients with indwelling urethr...
...ptoms compatible with CA-UTI include new onset...
...patients with spinal cord injury, increa...
...atheterized patient, pyuria is NOT di...
...nce, absence or degree of pyuria should...
...uria accompanying CA-ASB should NOT be interpreted...
...pyuria in a symptomatic patient suggests a di...
...terized patient, the presence or absence of od...
...r CA-ASB should NOT be done except in research...
...d in selected clinical situations such as...
...m "CA-bacteriuria" is used when no distinction...
Strategies
Strateg...
...ction of Inappropriate Urinary Catheter Inser...
...Unnecessary Catheterizatio...
...atheters should be placed only when they...
...ry catheters should not be used for the manag...
...hould develop a list of appropriate ind...
...hould require a physician’s order in the...
...utions should consider use of portab...
...ntinuation of Catheter...
...e risk of CA-bacteriuria (A, I)659...
...UTI, (A, II)659...
...-UTI. (A, II)65...
...s should consider automatic stop-orders to re...
...gies to Consider Prior to Catheter Insert...
...ction Prevention...
...itals and long-term-care facilities shoul...
...gies should include education and training o...
Institutions may consider feedback of CA...
...ufficient to make a recommendation as t...
...rnatives to Indwelling Urethral Cathete...
...m catheterization
...hort-term and ( A , II )659
...rm ( B , II )659
...tent catheterization
...-term or ( C , I )659...
...m ( A , III )659
...hort-term or ( C ,...
...rm ( A , III )65...
...rapubic catheteriz...
...-bacteriuria and ( B ,...
...TI. ( C , III )659...
...sertion Technique for Indwelling Urethral...
...urethral catheters should be inserte...
...mittent Catheterization Technique...
...an (non-sterile) rather than sterile technique...
...itutional ( B , I )659...
...tiple-use catheters may be considered instead...
...stitutional ( C , I )659...
...atheters are NOT recommended for routine u...
...CA-UTI. ( B , II )659...
...obial-Coated Catheters...
...n patients with short-term indwelling urethral...
...egies to Consider After Catheter Insertion...
...Catheter System...
...theter drainage system, with ports in the...
...d CA-UTI ( A , III )65...
in patients with short-term indwelling urethra...
...( A , III )in patients with long-t...
...tion-specific strategies should be deve...
and that the drainage bag and connec...
...nected system (catheter preattached to the tubing...
...iuria or ( A , I )659...
CA-UTI. ( A , III...
Prophylaxi...
short- ( A , II...
...erm ( A , II )659...
...amine salts should NOT be used rou...
...ic indwelling urethral or suprapubic ( A...
Methenamine salts may be considered for...
...using a methenamine salt to reduce CA-...
...anberry products should NOT be used...
...nced Meatal Care...
...meatal cleansing with povidone-iodin...
...er Irrigation...
...eriuria or ( A , I )659...
...( A , II )659...
...ion with antimicrobials may be considered in s...
...tion with normal saline should NOT be u...
...bials in the Drainage Bag...
...bacteriuria or ( A , I )...
...-UTI. ( A , I )65...
...e Catheter Change...
...fficient to make a recommendation as...
...imicrobials at Time of Catheter Removal o...
...the time of catheter placement to reduce CA-UT...
...t the time of catheter removal or ( B , I )659
...acement ( A , III )659...
...d Treatment of CA-ASB in Catheterized...
...t-term or ( A , II )...
...term ( A , I )659...
...reening and treatment of CA-ASB are NOT recommen...
...r catheterized patients ( A , III )659...
...pregnant women ( A , III )659...
...ergoing urologic procedures for which visible muco...
...d Treatment of CA-ASB at Catheter Rem...
...obial treatment of CA-ASB that persist...
...ne Culture and Catheter Replacement B...
...cimen for culture should be obtained prior t...
...atheter can be discontinued, a voided midstream...
If an indwelling catheter has been in place f...
...he urine culture should be obtained from the...
...r can be discontinued, a voided midstream...
...n of Treatment...
...patients with CA-UTI who have prompt resolution...
...ys is recommended in those with a delayed respo...
...day regimen of levofloxacin may be considered in...
...microbial regimen may be considered f...
...re 1. Urinary Catheters