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
...nitions and Diagnosis...
...A-ASB in patients with indwelling urethral, in...
CA-ASB in a man with a condom cathete...
...tients with indwelling urethral, indwelling supr...
...ns and symptoms compatible with CA-UTI includ...
...n patients with spinal cord injury, increased spas...
...terized patient, pyuria is NOT diagnostic of CA-b...
...presence, absence or degree of pyuria shoul...
...companying CA-ASB should NOT be interpreted...
...e absence of pyuria in a symptomatic pa...
...rized patient, the presence or abse...
...reening for CA-ASB should NOT be done exce...
...clinical situations such as pregnant women....
The term "CA-bacteriuria" is used when no di...
Strategies
Strategie...
...nappropriate Urinary Catheter Insertion and Du...
...necessary Catheterizatio...
Indwelling catheters should be placed on...
...elling urinary catheters should not be used f...
...stitutions should develop a list of appropriate...
...ould require a physician’s order in the ch...
...titutions should consider use of porta...
...iscontinuation of Ca...
...the risk of CA-bacteriuria (A, I)659...
...UTI, (A, II)659...
...-UTI. (A, II)659
...itutions should consider automatic stop-...
Strategies to Consider Prior to Catheter Insert...
...fection Prevention...
...s and long-term-care facilities should develop, m...
...s should include education and training of staff...
...utions may consider feedback of CA-bact...
...e insufficient to make a recommendation as...
...to Indwelling Urethral Catheterization...
...dom catheteriza...
to short-term and ( A , II...
...erm ( B , II )659...
...rmittent catheterizat...
...term or ( C , I )659...
...term ( A , III )659...
...hort-term or ( C , III )659...
...rm ( A , III )659...
...uprapubic catheter...
...iuria and ( B , I )659...
...I. ( C , III )6...
...ion Technique for Indwelling Urethral Catheter...
...dwelling urethral catheters should...
...mittent Catheterization Techniq...
...(non-sterile) rather than sterile technique may...
...itutional ( B , I )6...
Multiple-use catheters may be cons...
...d institutional ( C , I )6...
...catheters are NOT recommended for routine use to r...
...-UTI. ( B , II )659...
...bial-Coated Catheters
...h short-term indwelling urethral catheterization...
...revention Strategies to Consider After Cathete...
...sed Catheter System
...ter drainage system, with ports in the di...
...TI ( A , III )659...
...with short-term indwelling urethral or...
...I ( A , III )in patients with long-t...
...n-specific strategies should be develope...
...the drainage bag and connecting tube are...
...a preconnected system (catheter preattached t...
...acteriuria or ( A , I )659...
...( A , III )659...
Prophylaxi...
...hort- ( A , III )...
...r long-term ( A , II )659...
Methenamine salts should NOT be used rou...
...chronic indwelling urethral or supr...
...alts may be considered for the reduction...
...a methenamine salt to reduce CA-UTI,...
...ry products should NOT be used routinely...
...hanced Meatal Care
...atal cleansing with povidone-iodine solution,...
...theter Irrigatio...
...bacteriuria or ( A , I )6...
CA-UTI ( A , II )6...
...atheter irrigation with antimicrobials may...
...theter irrigation with normal saline should NOT...
...ials in the Drainage Bag...
...cteriuria or ( A , I...
...UTI. ( A , I )659...
...tine Catheter Ch...
...are insufficient to make a recommendati...
...rophylactic Antimicrobials at Time of Catheter Re...
...me of catheter placement to reduce CA-UTI or (...
...time of catheter removal or ( B , I )659...
replacement ( A , III )659
...reening and Treatment of CA-ASB in Cat...
...-term or ( A , II )659...
...-term ( A , I )659
...creening and treatment of CA-ASB are NOT recommen...
...erized patients ( A , III )659...
...xcept in pregnant women ( A ,...
...ergoing urologic procedures for whic...
...eatment of CA-ASB at Catheter Removal to Re...
...al treatment of CA-ASB that persists 4...
...re and Catheter Replacement Before...
...for culture should be obtained prior to ini...
...can be discontinued, a voided midstream u...
...ing catheter has been in place for more than 2...
...ne culture should be obtained from the fresh...
If the catheter can be discontinued, a...
...ion of Treatment...
...ients with CA-UTI who have prompt re...
...o 14 days is recommended in those with a delayed r...
...gimen of levofloxacin may be consi...
...3-day antimicrobial regimen may be consi...
...gure 1. Urinary Cath...