Evidence based management of catheter-associated urinary tract infections

Authors: B. Köves;  A. Hajdú;  P. Tenke;  T. E. Bjerklund Johansen
Authors‘ workplace: Department of Urology South-Pest Hospital
Published in: Urol List 2014; 12(3): 9-12


Catheter‑associated urinary tract infections (CAUTI) are a major source of hospital acquired infections with significant consequences to morbidity and mortality and having substantial financial implications. Therefore appropriate catheter care is of utmost importance. In this review we present an evidence‑based update on the management of CAUTI, with special emphasis on the different measures of prevention and treatment, such as infection control programs and reminder systems, surface material modifications of the foreign bodies, antibio­­tic prophylaxis, and the appropriate treatment of catheter associated symptomatic infections. An optimal technology to prevent CAUTI is still not available and although there are promising results with different approaches the most efficient means are still to avoid unnec­essary catheterizations and to remove catheters as soon as possible. Evidence based catheter management and adherence to guidelines is mandatory.

Key words:
catheter, bacteriuria, infection, CAUTI, prevention


1. Klevens RM, Edwards JR, Richards CL Jr et al. Estimating health care‑associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007; 122(2): 160– 166.

2. Stamm WE, Martin SM, Bennett JV. Epidemiology of nosocomial infection due to Gram‑negative bacilli: aspects relevant to development and use of vac­cines. J Infect Dis 1977; 136 (Suppl): S151– S160.

3. US department of health and human services, pub­lic health service. Agency for Health Care Policy and Research 1992: 115– 127.

4. Tenke P, Köves B, Johansen TE. An update on prevention and treatment of catheter‑associated urinary tract infections. Curr Opin Infect Dis 2014; 27(1): 102– 107. doi: 10.1097/ QCO.0000000000000031.

5. Centers for disease control and prevention. Available from: http:/ / www.cdc.gov/ nhsn/ acute‑care‑hospital/ CAUTI/ .

6. Press MJ, Metlay JP. Catheter‑associated urinary tract infection: does changing the definition change quality? Infect Control Hosp Epidemiol 2013; 34(3): 313– 315. doi: 10.1086/ 669525.

7. Johansen TE, Botto H, Cek M et al. Critical review of current definitions of urinary tract infections and proposal of an EAU/ ESIU classification system. Int J Antimicrob Agents 2011; 38 (Suppl): 64– 70. doi: 10.1016/ j.ijantimicag.2011.09.009.

8. Carapeti EA, Andrews SM, Bentley PG. Randomised study of sterile versus non‑sterile urethral catheterisation. Ann R Coll Surg Engl 1996; 78(1): 59– 60.

9. Schiotz HA. Antiseptic catheter gel and urinary tract infection after short‑term postoperative catheterization in women. Arch Gynecol Obstet 1996; 258(2): 97– 100.

10. Tenke P, Kovacs B, Bjerklund Johansen TE et al. European and Asian guidelines on management and prevention of catheter‑associated urinary tract infections. Int J Antimicrob Agents 2008; 31 (Suppl 1): S68– S78.

11. Leblebicioglu H, Ersoz G, Rosenthal VD et al. Impact of a multidimensional infection control ap­proach on catheter‑associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC). Am J Infect Control 2013; 41(10): 885– 891. doi: 10.1016/ j.ajic.2013.01.028.

12. Fakih MG, Heavens M, Ratcliffe CJ et al. First step to reducing infection risk as a system: evaluation of infection prevention processes for 71 hospitals. Am J Infect Control 2013; 41(11): 950– 954. doi: 10.1016/ j.ajic.2013.04.019.

13. Kanj SS, Zahreddine N, Rosenthal VD et al. Impact of a multidimensional infection control approach on catheter‑associated urinary tract infection rates in an adult intensive care unit in Lebanon: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis 2013; 17(9): e686– e690. doi: 10.1016/ j.ijid.2013.01.020.

14. Wald HL, Ma A, Bratzler DW et al. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 2008; 143(6): 551– 557. doi: 10.1001/ archsurg.143.6.551.

15. Gould CV, Umscheid CA, Agarwal RK et al. Guideline for prevention of catheter‑associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31(4): 319– 326. doi: 10.1086/ 651091.

16. Parry MF, Grant B, Sestovic M. Successful reduction in catheter‑associated urinary tract infections: focus on nurse‑directed catheter removal. Am J Infect Control 2013; 41(12): 1178– 1181. doi: 10.1016/ j.ajic.2013.03.296.

17. Magers TL. Using evidence‑based practice to reduce catheter‑associated urinary tract infections. Am J Nurs 2013; 113(6): 34– 42. doi: 10.1097/ 01.NAJ.0000430923.07539.a7.

18. Reid G, Habash M, Vachon D et al. Oral fluoroquinolone therapy results in drug adsorption on ureteral stents and prevention of bio­­film formation. Int J Antimicrob Agents 2001; 17(4): 317– 319, discus­sion: 319– 320.

19. Reid G, Potter P, Delaney G et al. Ofloxacin for the treatment of urinary tract infections and bio­­films in spinal cord injury. Int J Antimicrob Agents 2000; 13(4): 305– 307.

20. Shigeta M, Komatsuzawa H, Sugai M et al. Effect of the growth rate of Pseudomonas aeruginosa bio­­films on the susceptibility to antimicrobial agents. Chemotherapy 1997; 43(2): 137– 141.

21. Reid G. Biofilms in infectious disease and on medical devices. Int J Antimicrob Agents 1999; 11(3– 4): 223– 226, discussion: 237– 239.

22. Sofer M, Denstedt JD. Encrustation of bio­­materials in the urinary tract. Curr Opin Urol 2000; 10(6): 563– 569.

23. Tenke P, Köves B, Nagy K et al. Update on bio­­film infections in the urinary tract. World J Urol 2012; 30(1): 51– 57. doi: 10.1007/ s00345‑011‑0689‑9.

24. De Ridder DJ, Everaert K, Fernández LG et al. Intermittent catheterisation with hydrophilic‑coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial. Eur Urol 2005; 48(6): 991– 995.

25. Schumm K, Lam TB. Types of urethral catheters for management of short‑term voiding problems in hospitalised adults. Cochrane Database Syst Rev 2008; (2): CD004013. doi: 10.1002/ 14651858.CD004013.pub3.

26. Sarica S, Akkoc Y, Karapolat H et al. Comparison of the use of conventional, hydrophilic and gel‑lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. Eur J Phys Rehabil Med 2010; 46(4): 473– 479.

27. Li L, Ye W, Ruan H et al. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta‑analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94(4): 782– 787. doi: 10.1016/ j.apmr.2012.11.010.

28. Lusardi G, Lipp A, Shaw C. Antibio­­tic prophylaxis for short‑term catheter bladder drainage in adults. Cochrane Database Syst Rev 2013; 7: CD005428. doi: 10.1002/ 14651858.CD005428.pub2.

29. Niël‑Weise BS, van den Broek PJ. Urinary catheter policies for long‑term bladder drainage. Cochrane Database Syst Rev 2005; (1): CD004201.

30. Niël‑Weise BS, van den Broek PJ, da Silva EM et al. Urinary catheter policies for long‑term bladder drainage. Cochrane Database Syst Rev 2012; 8: CD004201. doi: 10.1002/ 14651858.CD004201.pub3.

31. Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2008; (1): CD001321. doi: 10.1002/ 14651858.CD001321.pub4.

32. Davies AJ, Desai HN, Turton S et al. Does instillation of chlorhexidine into the bladder of catheterized geriatric patients help reduce bacteriuria? J Hosp Infect 1987; (1): 72– 75.

33. Niël‑Weise BS, van den Broek PJ. Antibio­­tic policies for short‑term catheter bladder drainage in adults. Cochrane Database Syst Rev 2005; (3): CD005428.

34. Kumon H. Management of bio­­film infections in the urinary tract. World J Surg 2000; 24(10): 1193– 1196.

35. Rutala WA, Kennedy VA, Loflin HB et al. Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. Am J Med 1981; 70(3): 659– 663.

36. Warren JW, Tenney JH, Hoopes JM et al. A prospective microbio­­logic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146(6): 719– 723.

37. Raz R, Schiller D, Nicolle LE. Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection. J Urol 2000; 164(4): 1254– 1258.

38. Ortega M, Marco F, Soriano A et al. Epidemiology and prognostic determinants of bacteraemic catheter‑acquired urinary tract infection in a single institution from 1991 to 2010. J Infect 2013; 67(4): 282– 287. doi: 10.1016/ j.jinf.2013.06.003.

39. Zimakoff JD, Pontoppidan B, Larsen SO et al. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol 1995; 29(3): 299– 309.

40. Harding GK, Nicolle LE, Ronald AR et al. How long should catheter‑acquired urinary tract infection in women be treated? A randomized controlled study. Ann Intern Med 1991; 114(9): 713– 719.

41. Nicolle LE. Catheter‑related urinary tract infection. Drugs Aging 2005; 22(8): 627– 639.

42. Nicolle LE. A practical guide to antimicrobial management of complicated urinary tract infection. Drugs Aging 2001; 18(4): 243– 254.

43. Peterson J, Kaul S, Khashab M et al. A double‑blind, randomized comparison of levofloxacin 750 mg once‑daily for five days with ciprofloxacin 400/ 500 mg twice‑daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 2008; 71(1): 17– 22. doi: 10.1016/ j.urology.2007.09.002.

44. Bonkat G, Widmer AF, Rieken M et al. Microbial bio­­film formation and catheter‑associated bacteriuria in patients with suprapubic catheterisation. World J Urol 2013; 31(3): 565–571. doi: 10.1007/s00345‑012‑0930‑1.

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