Management of Catheter-Associated Urinary Tract Infections

The most common source of nosocomial infections is the catheterized urinary tract. The main risk factor for catheter-associated urinary tract infections (CA-UTIs) is the duration of catheterization. In chronically catheterized patients, bacteriuria is considered universal and is usually polymicrobial. For these reasons, unnecessary catheter use should be avoided as much as possible, and the duration of catheterization should be minimized. Moreover, the placement of catheters into the bladder should be based on strict indications. The catheter insertion, removal, and catheter care should also be conducted in accordance with hygienic protocols, the catheter system should remain closed, and cross-infection must be avoided. Therefore, education of the staff is essential. Asymptomatic catheter-associated bacteriuria should not be routinely diagnosed and treated. On the other hand, symptomatic CA-UTIs should be treated with antibiotics. However, recognizing the symptoms of UTI is often difficult, since they might be atypical in catheterized patients, and require thorough inspection, evaluation, and exclusion of other sources of infection. The empirical treatment of the diagnosed CA-UTI is usually initiated with broad-spectrum antibiotics, based on local susceptibility patterns, until urine culture results become available. Treatment should be adjusted to the antibiotic susceptibility of the cultured bacteria using narrower spectrum antibiotics. Before the initialization of antibiotic therapy in chronically catheterized patients, it is reasonable to change the catheter, since biofilm formation on its surface creates a perfect environment for the selection of multidrug-resistant bacteria, especially if treated with antibiotics repeatedly.