Skip to main content

Advertisement

Log in

Diagnosis and Management of Catheter-Associated Urinary Tract Infection

  • Infectious Disease (H. Nguyen, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The widespread use of urinary catheters is associated with a rising number of catheter-associated infections (CA-UTI) and the approach to these infections presents a diagnostic challenge due to difficulty in differentiating this entity from catheter-associated asymptomatic bacteriuria (CA-ASB). This article reviews the current literature regarding diagnosis, microbiology, treatment, and prevention of CA-UTIs.

Recent Findings

Misconceptions surrounding diagnostic technique and indications for testing result in unneeded antimicrobial administration. Due to the substantial burden of CA-UTIs, much emphasis has been placed on prevention and the most successful prevention strategies are aimed at behavioral changes to minimize unnecessary catheterizations.

Summary

There are significant clinical sequelae of CA-UTIs and they pose a substantial burden on the healthcare system. Clinicians must accurately diagnose and manage CA-UTIs to prevent unnecessary antibiotic use which often leads to increasing antimicrobial resistance. In an effort to prevent CA-UTIs, healthcare systems should focus on prevention of unnecessary urinary catheterizations or prompt removal of urinary catheters once they are no longer indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Klevens RM, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–6.

    PubMed  PubMed Central  Google Scholar 

  2. Jacobsen SM, et al. Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 2008;21(1):26–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol. 1996;17(8):552–7.

    Article  CAS  PubMed  Google Scholar 

  4. Hooton TM, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–63.

    Article  PubMed  Google Scholar 

  5. Center for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Overview. 2016 January. http://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf.

  6. Weinstein JW, et al. A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol. 1999;20(8):543–8.

    Article  CAS  PubMed  Google Scholar 

  7. Ducharme J, Neilson S, Ginn JL. Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms? CJEM. 2007;9(2):87–92.

    Article  PubMed  Google Scholar 

  8. Pallin DJ, et al. Urinalysis in acute care of adults: pitfalls in testing and interpreting results. Open Forum Infect Dis. 2014;1(1):ofu019.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cope M, et al. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis. 2009;48(9):1182–8.

    Article  PubMed  Google Scholar 

  10. Press MJ, Metlay JP. Catheter-associated urinary tract infection: does changing the definition change quality? Infect Control Hosp Epidemiol. 2013;34(3):313–5.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Trautner BW, et al. Development and validation of an algorithm to recalibrate mental models and reduce diagnostic errors associated with catheter-associated bacteriuria. BMC Med Inform Decis Mak. 2013;13:48.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sievert DM, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14.

    Article  PubMed  Google Scholar 

  13. Grigoryan L, et al. A comparison of the microbiologic profile of indwelling versus external urinary catheters. Am J Infect Control. 2014;42(6):682–4.

    Article  PubMed  Google Scholar 

  14. Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract Urol. 2008;5(11):598–608.

    Article  CAS  PubMed  Google Scholar 

  15. Rishpana MS, Kabbin JS. Candiduria in catheter associated urinary tract infection with special reference to biofilm production. J Clin Diagn Res. 2015;9(10):DC11-3.

    PubMed  Google Scholar 

  16. Barford JM, et al. A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip. BJU Int. 2008;102(1):67–74.

    Article  PubMed  Google Scholar 

  17. Macleod SM, Stickler DJ. Species interactions in mixed-community crystalline biofilms on urinary catheters. J Med Microbiol. 2007;56(Pt 11):1549–57.

    Article  PubMed  Google Scholar 

  18. Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643–54.

    Article  PubMed  Google Scholar 

  19. Widmer M, et al. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2015;11:CD000491.

    PubMed  Google Scholar 

  20. Harding GK, et al. How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. Ann Intern Med. 1991;114(9):713–9.

    Article  CAS  PubMed  Google Scholar 

  21. Jarrell AS, et al. Short-duration treatment for catheter-associated urinary tract infections in critically ill trauma patients. J Trauma Acute Care Surg. 2015;79(4):649–53.

    Article  PubMed  Google Scholar 

  22. Peterson J, 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.

    Article  PubMed  Google Scholar 

  23. •• Dull RB, et al. Antimicrobial treatment of asymptomatic bacteriuria in noncatheterized adults: a systematic review. Pharmacotherapy. 2014. 34(9): 941–60. In this systematic review of 17 clinical trials, screening and treatment of asymptomatic bacteriuria in elderly adults, nonpregnant premenopausal women, and diabetic women led to no improvement in morbidity and mortality; rather, adverse effects of antibiotic treatment were noted in several of the clinical trials. This article further supports education and routine audit/feedback to decrease screening and treatment of ASB.

  24. Khawcharoenporn T, et al. Abnormal urinalysis finding triggered antibiotic prescription for asymptomatic bacteriuria in the ED. Am J Emerg Med. 2011;29(7):828–30.

    Article  PubMed  Google Scholar 

  25. Lin E, et al. Overtreatment of enterococcal bacteriuria. Arch Intern Med. 2012;172(1):33–8.

    Article  PubMed  Google Scholar 

  26. • Cai T, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections. Clin Infect Dis. 2015;61(11): 1655–61. In this randomized controlled trial, women suffering from recurrent urinary tract infections were significantly more likely to develop UTIs if treated for asymptomatic bacteriuria. This study demonstrates the risks of inappropriate treatment of asymptomatic bacteriuria.

  27. • Trautner BW et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med. 2015;175(7): 1120–7. This pre-post interventional study demonstrated the effectiveness of a multifaceted intervention aimed to decrease inappropriate antibiotic use for CA-ASB. Both urine culture ordering and treatment for CA-ASB decreased significantly with the implementation of a CA-UTI diagnostic algorithm and audit and feedback intervention.

  28. Saint S, et al. Preventing catheter-associated urinary tract infection in the United States: a national comparative study. JAMA Intern Med. 2013;173(10):874–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Meddings J, et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51(5):550–60.

    Article  PubMed  Google Scholar 

  30. Meddings J, et al. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf. 2014;23(4):277–89.

    Article  PubMed  Google Scholar 

  31. Chen YY, et al. Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections. Am J Crit Care. 2013;22(2):105–14.

    Article  PubMed  Google Scholar 

  32. Davis KF, et al. Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics. 2014;134(3):e857–64.

    Article  PubMed  Google Scholar 

  33. Niel-Weise BS, et al. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev. 2012;8:CD004201.

    PubMed  Google Scholar 

  34. Petronella P, et al. Antibiotic prophylaxis in catheter-associated urinary infections. New Microbiol. 2012;35(2):191–8.

    PubMed  Google Scholar 

  35. Pickard R, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet. 2012;380(9857):1927–35.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Noto MJ, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA. 2015;313(4):369–78.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cunha M, et al. Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization: a systematic review. Rev Esc Enferm USP. 2013;47(6):1410–6.

    Article  PubMed  Google Scholar 

  39. Beerepoot M, Geerlings S. Non-antibiotic prophylaxis for urinary tract infections. Pathogens. 2016;5(2):36.

    Article  PubMed Central  Google Scholar 

  40. Cai T, et al. Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study. World J Urol. 2014;32(4):1007–14.

    Article  PubMed  Google Scholar 

  41. Palka MA. Evidenced based review of recommendations addressing the frequency of changing long-term indwelling urinary catheters in older adults. Geriatr Nurs. 2014;35(5):357–63.

    Article  PubMed  Google Scholar 

  42. Echols RM, et al. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clin Infect Dis. 1999;29(1):113–9.

    Article  CAS  PubMed  Google Scholar 

  43. Czaja CA, et al. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007;45(3):273–80.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Valerie Burstein for her assistance with formatting.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Larissa May or Daniel Okamoto.

Ethics declarations

Conflict of Interest

Dr. May and Dr. Okamoto declare no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Infectious Disease.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

May, L., Okamoto, D. Diagnosis and Management of Catheter-Associated Urinary Tract Infection. Curr Emerg Hosp Med Rep 4, 136–140 (2016). https://doi.org/10.1007/s40138-016-0108-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-016-0108-z

Keywords

Navigation