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
...initions and Diagnosis...
...ts with indwelling urethral, indwelling suprapubi...
...A-ASB in a man with a condom catheter is define...
...nts with indwelling urethral, indwelling supr...
...and symptoms compatible with CA-UTI include new...
In patients with spinal cord injury, in...
...he catheterized patient, pyuria is NOT diag...
...e, absence or degree of pyuria shoul...
...yuria accompanying CA-ASB should NOT be...
...ence of pyuria in a symptomatic pat...
...heterized patient, the presence or absen...
...ning for CA-ASB should NOT be done ex...
...ted clinical situations such as pregnant women....
...bacteriuria" is used when no distinc...
Strategies
...rategies
...appropriate Urinary Catheter Inser...
...necessary Catheterization...
...eters should be placed only when they are indi...
...ng urinary catheters should not be...
...nstitutions should develop a list of appropriate...
...ould require a physician’s order in the c...
...should consider use of portable bl...
...inuation of Catheter
...isk of CA-bacteriuria (A, I)659...
...A-UTI, (A, II)659
...UTI. (A, II)659...
...ns should consider automatic stop-orders to redu...
...es to Consider Prior to Catheter Insertion...
Infection Preventio...
...long-term-care facilities should develop,...
...uld include education and training of staf...
...s may consider feedback of CA-bacter...
Data are insufficient to make a recommendatio...
Alternatives to Indwelling Urethral Catheterizati...
...catheterization...
...o short-term and ( A , II )659
...term ( B , II )659...
...ttent catheterization...
...term or ( C , I )659...
...m ( A , III )659...
...rt-term or ( C , III )659...
long-term ( A , III )659
...rapubic catheterizatio...
...riuria and ( B , I )659...
CA-UTI. ( C , III )65...
...tion Technique for Indwelling Urethral C...
...ng urethral catheters should be in...
...mittent Catheterization Te...
...on-sterile) rather than sterile techniqu...
...institutional ( B , I...
...ultiple-use catheters may be conside...
...institutional ( C , I )659
Hydrophilic catheters are NOT recommen...
...CA-UTI. ( B , II )659...
...imicrobial-Coated Cath...
...patients with short-term indwelling urethral cat...
...trategies to Consider After Catheter Insertion...
...losed Catheter Sys...
...losed catheter drainage system, with ports in the...
...CA-UTI ( A , III )6...
in patients with short-term indwelling urethra...
...UTI ( A , III )in patients with lon...
...tion-specific strategies should be devel...
...rainage bag and connecting tube are always kept...
...reconnected system (catheter preatta...
...iuria or ( A , I )65...
...-UTI. ( A , III...
...phylaxis...
...( A , III )659...
...ng-term ( A , II )659...
...ine salts should NOT be used routinely t...
...chronic indwelling urethral or suprapubic...
...e salts may be considered for the reduction of...
...using a methenamine salt to reduce CA-UTI,...
...anberry products should NOT be used routinely to r...
...anced Meatal Car...
...meatal cleansing with povidone-iodine solution...
...er Irrigation
...eriuria or ( A , I )659...
...( A , II )65...
...tion with antimicrobials may be considere...
...irrigation with normal saline should...
...ntimicrobials in the Dra...
...riuria or ( A , I )659
...( A , I )659...
Routine Catheter Chang...
...insufficient to make a recommendati...
...Antimicrobials at Time of Catheter Removal...
...the time of catheter placement to r...
...ime of catheter removal or ( B , I )6...
...ement ( A , III )659...
...d Treatment of CA-ASB in Catheterized Patients t...
...ort-term or ( A ,...
...-term ( A , I )659...
...g and treatment of CA-ASB are NOT rec...
...catheterized patients ( A , III...
...pregnant women ( A , III )65...
...ts undergoing urologic procedures for whi...
...ening and Treatment of CA-ASB at Cat...
...microbial treatment of CA-ASB that p...
...re and Catheter Replacement Before T...
...imen for culture should be obtaine...
...atheter can be discontinued, a void...
...indwelling catheter has been in place for more t...
...urine culture should be obtained fr...
...catheter can be discontinued, a void...
...ion of Treatment...
...with CA-UTI who have prompt resolutio...
...s is recommended in those with a delaye...
A 5-day regimen of levofloxacin may be cons...
...3-day antimicrobial regimen may be considered...
.... Urinary Catheters...