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- Catheter Assoviated Urinary Tract Infection And Answers The Following Questions I Will Like Ot Back Abstractcatheter 1 (28.12 KiB) Viewed 35 times
Catheter-associated urinary tract infections (CAUTIs) are a major source of noso-
comial infections and represent a significant burden in morbidity and costs.
Although several different approaches to disease prevention are being investigated,
the most effective methods of prevention are to avoid unnecessary catheterisations
and to remove catheters as soon as possible. An optimal catheter material or
coating is still awaited. The growing number of publications regarding implemen-
tation of reminder systems and infection control programs shows the importance
of these measures, which can effectively decrease the rate of CAUTIs. Systemic
antibiotic prophylaxis is not recommended for long-termindwelling catheterisa-
tion. Treatment of catheter-related asymptomatic bacteriuria should be avoided, as
this may increase the rate of antibiotic resistance without eradicating the bacteria.
Systemic antibiotic treatment is indicated only for symptomatic CAUTIs. Alterna-
tive methods of urinary drainage may be preferable to indwelling urethral cathe-
terisation. Evidence-based catheter management and treatment of CAUTIs are
mandatory.
Patient summary: This review summaries different management options for the
prevention and treatment of catheter-associated urinary tract infections. Treat-
ment for bacteria in catheterised urine in the absence of symptoms should, be
avoided, as this may increase the rate of antibiotic resistance without eradicating
the bacteria. Systemic antibiotic treatment is indicated only for symptomatic
infections. The most effective methods of prevention are to avoid unnecessary
catheterisation and to remove catheters as soon as possible.
© 2016 Published by Elsevier B.V. on behalf of European Association of Urology.
- Catheter Assoviated Urinary Tract Infection And Answers The Following Questions I Will Like Ot Back Abstractcatheter 2 (107.4 KiB) Viewed 35 times
- Catheter Assoviated Urinary Tract Infection And Answers The Following Questions I Will Like Ot Back Abstractcatheter 3 (107.4 KiB) Viewed 35 times
according to the Oxford Centre for Evidence- modification of the US Department of Health and Human Services classification (4). 2. CAUTI pathogenesis The first step in CAUTI pathogenesis is the development of biofilms on the surfaces of catheters. Biofilms are structured communities of microorganisms encapsulated within a self- developed polymeric matrix that adheres to a surface, and they have a major impact on foreign bodies, implants, and devices placed in the human body (5). Biofilm bacteria may differ from their planktonic counterparts in antibiotic susceptibility and phenotype, explaining why antimicrobial therapies effective against planktonic bacteria frequently fail to eradicate bacterial biofilms on catheters and other urologic devices. Approximately 20% of patients are colonised immediately at the time of catheter insertion, as bacteria can ascend through the catheter lumen via reflux of urine from contaminated bags (intraluminal route) or from the urethra along the extraluminal catheter-urethral surface. The risk of bacteriuria increases by 3-10% for every day after catheter insertion, and bacteriuria is considered universal after 30 d (6) 3. Definition and diagnosis In the case of asymptomatic catheter-associated bacteriuria (CAB), bacteria are present in the urine of an asymptomatic catheterised patient. The National Healthcare Safety Net- work (NHSN), the patient safety surveillance system of the Centers for Disease Control and Prevention (CDC). defines CAUTI as a UTI episode for which an indwelling catheter was in place for >2 d on the date of diagnosis (day of device placement being day 1). and an indwelling urinary catheter was in place on the date of the event or the day before. If an indwelling catheter was in place for >2d and then removed, the UTI criteria must be met on the day of discontinuation or the next day 17). In 2009, the NHSN removed asymptomatic bacteriuria removed from the CAUTI definition. This change Great efforts have been invested and many different approaches have been investigated in the last few decades to prevent or at least delay CAB and CAUTI. Although an ideal solution has not yet been identified, many important issues regarding catheter care and catheter-related infec- tions have been carified. The following general recom- mendations are commonly used [10] (III): . A closed catheter system should be used (B). • The duration of catheterisation should be minimal (A • Catheters should be introduced under antiseptic condi- tions (B). • There is limited evidence that the risk of bacteriuria is equally high if a sterile or clean technique or an antiseptic gel is used (lla). • The drainage bag should be kept below the level of the bladder and the connecting tube (8). . An indwelling catheter should always be introduced by trained personnel. • Urethral trauma should be minimised by the use of adequate lubricant and the smallest possible catheter calibre. 4.1. Reminder systems and infection control programs Prevention of CAB and CAUTI starts with prevention of unnecessary catheterisation. In addition, catheters are often left in place in patients without purpose. The use of different reminder systems (eg, electronic, nurse-basl) is recom- mended by the guidelines to decrease catheterisation duration (10,11). Institutions that have implemented and evaluated such monitoring systems uniformly reported reductions in catheterisation duration and CAUTI incidence 112-141 Institutional infection control programs and catheter care practice bundles (education for catheter insertion management, and removal: improving hand hygiene) can effectively reduce the rate of CAUTIs and CAUTI-related complications (12.15.16).