Catheter-associated urinary tract infection

Catheter-associated Urinary Tract Infection (CAUTI)

Catheter-associated urinary tract infections (CAUTIs) are a significant concern in healthcare settings, particularly in hospitals and long-term care facilities. They occur when bacteria or fungi enter the urinary tract through a urinary catheter, leading to infection. CAUTIs are the most common type of healthcare-associated infection (HAI) and can lead to serious complications if not properly managed.

Overview

A urinary catheter is a tube inserted into the bladder through the urethra to drain urine. It is often used in patients who are unable to urinate on their own, during surgery, or for other medical reasons. However, the presence of a catheter increases the risk of infection because it provides a direct pathway for pathogens to enter the bladder.

Pathophysiology

The pathogenesis of CAUTI involves the colonization of the urinary tract by microorganisms. The catheter can introduce bacteria from the external environment into the bladder, bypassing the body's natural defenses. Common pathogens include Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Biofilm formation on the catheter surface can further complicate treatment, as biofilms protect bacteria from antibiotics and the host immune response.

Risk Factors

Several factors increase the risk of developing a CAUTI:

• Prolonged use of a urinary catheter
• Female gender
• Advanced age
• Diabetes mellitus
• Immunosuppression
• Poor catheter care and hygiene

Symptoms

Symptoms of CAUTI can include:

• Fever
• Chills
• Lower abdominal pain
• Cloudy or foul-smelling urine
• Hematuria (blood in urine)
• Confusion or delirium, especially in elderly patients

Diagnosis

Diagnosis of CAUTI is based on clinical symptoms and laboratory tests. Urinalysis and urine culture are commonly used to identify the presence of bacteria and determine the appropriate antibiotic treatment.

Prevention

Preventing CAUTI involves several strategies:

• Limiting the use of urinary catheters to only when necessary
• Ensuring proper catheter insertion and maintenance techniques
• Using aseptic technique during catheter insertion
• Regularly assessing the need for continued catheterization
• Implementing catheter care bundles and protocols

Treatment

Treatment of CAUTI typically involves the removal or replacement of the catheter and the administration of appropriate antibiotics based on culture results. In some cases, additional interventions may be necessary to address complications.

Also see

• Urinary tract infection
• Healthcare-associated infection
• Biofilm
• Antibiotic resistance