Catheter associated urinary tract infections

Lindsay E Nicolle, Lindsay E Nicolle

Abstract

Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.

Keywords: Bacteriuria; Health care acquired infection; Indwelling urethral catheter; Urinary catheter; Urinary tract infection.

References

    1. Zarb P, Coignard B, Griskevicienne J, Muller A, Vankerckho ven Weist K, Goossens MM, Vaerenberg S, Hopkins S, Catry B, Monnet DL, Goosens H, Suetens C. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill. 2012;17(46):pil=20316.
    1. Magill SS, Edwards JR, Bamberg W, Beldaus ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson D, Wilson LE, Fridkin SK. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370:1198–1208.
    1. Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-Associated Module, Atlanta: CDC. 2013. .
    1. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambyah PA, Tenke P, Nicolle LE. 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;50:625–663.
    1. Stark RP, Maki DG. Bacteriuria in the catheterized patient. What quantitative level of bacteriuria is relevant? N Engl J Med. 1984;311:560–564.
    1. Brennan BM, Coyle JR, Marchaim D, Pogue JM, Boehme M, Finks J, Malani AN, Verhec KE, Buckley BO, Mollon N, SUrdin DR, Washer LL, Kaye KS. Statewide surveillance of carbapenem-resistant Enterobacteriaceae in Michigan. Infection Control Hosp Epidemiol. 2014;35:342–349.
    1. Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis L, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:464–479.
    1. Arnoldo L, Migliavasca R, Regastin L, Raglio A, Pagani L, Nucleo E, Spalla M, Vailati F, Agodi A, Mosea A, Zoth C, Tardivo S, Bianco I, Rulli A, Gualdi P, Panetta P, Pasini C, Pedroni M, Brusaferro S. Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterized inpatients in Italian long term care facilities. BMC Infect Dis. 2013;13:124.
    1. Mody L, Matieshwari S, Galecki A, Kauffman CA, Bradley SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc. 2007;55:1921–1926.
    1. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic. Arch Intern Med. 2000;160:678–687.
    1. Leuck A-M, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters – is infection the greatest risk? J Urol. 2012;187:1662–1666.
    1. Pickard R, Lam T, MacLennan G, Starr K, Kilonzo M, McPherson G, Gillies K, McDonald A, Walton K, Buckley B, Glazener C, Boachie C, Burr J, Norrie J, Vale L, Grant A, Nidow J. Types of urethral catheter for reducing symptomatic urinary tact infections in hospitalized adults requiring short-term catheterization: multicenter randomized controlled trial and economic evaluation of antimicrobial- and antiseptic-impregnated urethral catheters (the CATHETER trial) Health Technol Assess. 2012;16(47) doi:10.3310/hta16470.
    1. Venhems P, Baratin D, Voirin N, Savey A, Caillat-Vallet E, Metzger M-H, Lepape A. Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program. Eur J Epidemiol. 2008;23:641–645.
    1. Gastmeier P, Behnke M, Schwab F, Geffers C. Benchmarking of urinary tract infection rates, experiences from the intensive care unit component of the German national nosocomial infections surveillance system. J Hosp Infect. 2011;78:41–44.
    1. Rosenthal VD, Todi SK, Alvarez-Moreno C, Pawar M, Karlekar A, Zeggwagh AA, Mitrev Z, Udwadia FE, Navoa-Ng JA, Chakravarthy M, Salomao R, Sahu S, Dilek A, Kanj SS, Guanche-Garcell H, Cuellar LE, Ersoz G, Nevzat-Yolein A, Jagg N, Madeiros EA, Ye G, Akan DA, Mapp T, Castenada-Sabogal A, Matta-Cortes L, Sirmate IF, Olark N, Torres-Hernandes H, Barahona-Guzman N, Fernandez-Hidalgo R. et al.Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium. Infection. 2012;40:517–526.
    1. Giks A, Roumbelaki M, Bagatzoumi-Pieridou D, Alexandrou M, Zinseri V, Dimitradis I, Krixtsotaks EI. Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study. Infection. 2010;38:165–171.
    1. Burton DC, Edwards JR, Srinivasion A, Fredkin SK, Gould CV. Trends in catheter-associated urinary tract infections in adult intensive care units – United States, 1990–2007. Infect Control Hosp Epidemiol. 2011;32:748–756.
    1. Crnich CJ, Drinka P. Medical device-associated infections in the long-term care setting. Infect Dis Clin North Am. 2012;26:143–164.
    1. Eilers R, Veldman-Ariesen MJ, Van Bentham BH. Prevalence and determinants associated with healthcare-associated infections in long-term care facilities in the Netherlands, May to June 2010. Euro Surveill. 2012;17(34):pil=20252.
    1. Moro ML, Ricchizzi E, Morsillo F, Marchi M, Purs V, Zotti CM, Prato R, Privitera G, Poli A, Mora I, Fedeli U. Infections and antimicrobial resistance in long term care facilities: a national prevalence study. Ann Ig. 2013;25:109–118.
    1. Heudorf L, Boehicke K, Schade M. Healthcare-associated infections in long-term care facilities in Frankfurt am Main, Germany, January to March 2011. Euro Surveill. 2012;17(35):pil=20256.
    1. Jonsson K, Loft A-L E, Nasic S, Hedelin H. A prospective registration of catheter life and catheter interventions in patients with long-term indwelling catheters. Scand J Urol Nephrol. 2011;45:401–403.
    1. Stevenson KB, Moore J, Colwell H, Sleeper B. Standardized infection surveillance in long-term care: interfacility comparisons from a regional cohort of facilities. Infect Control Hosp Epidemiol. 2004;25:985–994.
    1. Nicolle LE. Urinary catheter associated infections. Infect Dis Clin North Am. 2012;26:13.28.
    1. Warren JW, Damron D, Tenney JH, Hoopes JM, Deforge B, Muncie HL Jr. Fever, bacteremia and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis. 1987;155:1151–1158.
    1. Fortin E, Rocher I, Frenette C, Temblay C, Quach C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Quebec Provincial Surveillance results. Infect Control Hosp Epidemiol. 2012;33:456–462.
    1. Mylotte JM. Nursing home acquired bloodstream infection. Infect Control Hosp Epidemiol. 2005;26:838–837.
    1. Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med. 2009;25:423–436.
    1. Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A, Chang R, Saint S. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013;159:401–410.
    1. Saint S, Baker PD, McDonald LL, Ossenkop K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc. 1999;47:1453–1457.
    1. Chant C, Smith DM, Marshall JC, Friedrich JO. Relationship of catheter associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med. 2011;39:1167–1173.
    1. Kunin CM, Chin QF, Chambers S. Morbidity and mortality associated with indwelling urinary catheters in elderly patients in a nursing home – confounding due to the presence of associated diseases. J Am Geriatr Soc. 1987;35:1001–1006.
    1. Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract Urol. 2008;5(11):598–608.
    1. Nicolle LE. The chronic indwelling catheter and urinary infection in long term care facility residents. Infect Control Hosp Epidemiol. 2001;22:316–321.
    1. Warren JW. The catheter and urinary tract infection. Med Clin North Am. 1991;75:481–493.
    1. Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis. 1982;146:719–723.
    1. Greene MT, Chang R, Kuhn L, Rogers MA, Chenoweth CE, Shuman E, Saint S. Predictors of hospital-acquired urinary tract-related bloodstream infection. Infect Control Hosp Epidemiol. 2012;33:1001–1007.
    1. Chang R, Greene MT, Chenoweth CE, Kuhn L, Shuman E, Rogers NAM, Saint S. Epidemiology of hospital-acquired urinary-tract related blood stream infection at a university hospital. Infect Control Hosp Epidemiol. 2011;32:1127–1129.
    1. Melzer M, Welch C. Outcomes in UK patients with hospital-acquired bacteremia and the risk of catheter-associated urinary tract infections. Postgrad Med J. 2013;89:329–334.
    1. Sader HS, Flamm RK, Jones RN. Frequency of occurrence and antimicrobial susceptibility of Gram-negative bacteremia isolates in patients with urinary tract infection: results from United States and European hospitals (2009–2011) J Chemother. 2014;26:133–138.
    1. Ortega M, Marco F, Soriano A, Almela M, Martinez JA, Pitart C, Mensa J. Epidemiology and proynostic determinants of bacteremic catheter acquired urinary tract infection in a single institution from 1991–2010. J Infect. 2013;67:282–287.
    1. Matsukawa M, Kunishima Y, Takahashi S, Takeyama K, Tsukamoto T. Bacterial colonization on intraluminal surface of urethral catheter. Urology. 2005;65:440–444.
    1. Mobley HT. In: Urinary tract infections: molecular pathogenesis and clinical management. Mobley HL, Warren JW, editor. Washington DC: ASM Press; 1996. Virulence of Proteus mirabilis; pp. 245–270.
    1. Getliffe KA, Mulhall AB. The encrustation of indwelling catheters. Br J Urol. 1991;67:337–341.
    1. Stickler DJ, Zimakoff J. Complications of urinary tract infections associated with devices used for long-term bladder management. J Hosp Infect. 1994;28:177–194.
    1. Getliffe KA. The characteristics and management of patients with recurrent blockage of long-term urinary catheters. J Adv Nurs. 1994;20:140–149.
    1. Kohler-Ockmore J, Feneley RC. Longterm catheterization of the bladder: prevalence and morbidity. Br J Urol. 1996;77:347–351.
    1. Jones BD, Mobley HL. Genetic and biochemical diversity of ureases of Proteus, Providencia, and Morganella species isolated from urinary tract infection. Infect Immun. 1987;55:2198–2203.
    1. Jacobsen SM, Stickler DJ, Mobley HL, Shirtliff ME. Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 2008;21:26–59.
    1. Stickler D, Morris N, Moreno MC, Sabbaba N. Studies on the formation of crystalline bacterial biofilms on urethral catheters. Eur J Clin Microbiol Infect Dis. 1998;17:649–652.
    1. Tenney JH, Warren JW. Bacteriuria in women with long term catheters: paired comparison of indwelling and replacement catheters. J Infect Dis. 1988;157:199–207.
    1. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control Practices Advisory Committee (HICPAC): guideline for prevention of catheter-associated urinary tract infections. 2009. .
    1. Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW. Epic Guideline Development Team. Guidelines for preventing infections associated with the insertion and maintenance of short-term indwelling urethral catheters in acute care. J Hosp Infect. 2001;47(suppl):S39–S46.
    1. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox MH. Epic 2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007;65(suppl):S1–S64.
    1. Fakih MG, Watson SR, Green MT, Kennedy EH, Olmsted RN, Krein SL, Saint S. Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med. 2012;172:255–260.
    1. Marigliano A, Barbadoro P, Pennacchietti L, D’Errico MM, Prospero E. Active training and surveillance: two good friends to reduce urinary catheterization rate. Am J Infect Control. 2012;40:692–695.
    1. Titsworth WL, Hester J, Correia T, Reed R, Williams M, Guin P, Layon AJ, Archibald LK, Mocco J. Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution’s success. J Neurosurg. 2012;116:911–920.
    1. Saint S, Kowalski CP, Forman J, Damschroder L, Hofer TP, Kaufman SR, Creswell JW, Krein SL. A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol. 2008;29:333–341.
    1. Saint S, Olmsted RN, Fakih MG, Kowalski CP, Watson SR, Sales AE, Krein SL. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf. 2009;35:449–455.
    1. Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf. 2013. Electronically published ahead of print. doi:10.1136/bmjqs-2012-001774.
    1. Johnson JR, Roberts PL, Olsen RJ, Moyer KA, Stamm WE. Prevention of catheter-associated urinary tract infection with a silver-oxide-coated urinary catheter: clinical and microbiologic correlation. J Infect Dis. 1990;162:1145–1150.
    1. Srinivasan A, Karchmer T, Richards A, Song X, Perl T. A prospective trial of a novel, silicone-based, silver-coated Foley catheter for the prevention of nosocomial urinary tract infection. Infect Control Hosp Epidemiol. 2006;27:38–43.
    1. Riley DK, Classen DC, Stevens LE, Burke JP. A large, randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med. 1995;98:349–356.
    1. Huth TS, Burke JP, Larsen RA, Classen DC, Stevens LE. Randomized trial of meatal care with silver sulfadiazine cream for the prevention of catheter-associated bacteriuria. J Infect Dis. 1992;165:14–18.
    1. Fakih MG, Greene MT, Kennedy EH, Meddings JA, Krein SL, Olmsted RN, Saint S. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control. 2012;40:359–364.
    1. Burns AC, Petersen NJ, Garza A, Arya M, Patterson JE, Naik AD, Trautner BW. Accuracy of a urinary catheter surveillance protocol. Am J Infect Control. 2012;40:55–58.
    1. Smith P, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: infection prevention and control in the long-term care facility. Infect Control Hosp Epidemiol. 2008;29:785–814.

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