SandboxAB

Overview

About 15-25% of hospitalized patients have got a urinary catheter during in-patient management. Catheter associated bacteriuria is the most common infection during hospitalization. however,less than quarter of hospitalized patient develop symptomatic urinary tract infection.

Definition

Catheter associated urinary tract infection is defined by the presence of urinary tract infection symptoms or signs in patients with or indwelling or suprapubic catheters with isolation of one or more bacterial strains≥10³cfu/ml from catheter assembled urine specimen or midstream voided urine specimen in patients who had a catheter removed in the last 48 hours. And this is applied after exclusion of other possible sources of infection.

Catheter associated UTI signs and symptoms

General signs and symptoms
Non specific presentations are the most common. The new onset or worsening of any of the following :

• Fever
• Rigors
• Altered mental status
• Malaise or lethargy

After exclusion of alternative diagnosis with thorough evaluation.

Urinary tract specific signs and symptom

• Flank pain
• Costovertebral angel tenderness
• Acute hematuria
• Pelvic discomfort

After catheter removal

• Urgency
• Frequency
• Dysuria
• Suprapubic pain or tenderness

Patients with spinal cord injury

• Increased spasticity
• Autonomic dysreflexia
• Sence of unease

Pathogenesis and Microbiology

Urinary catheterization disturbs the normal uroepithelial barrier, allowing uropathgenes to access through the lamina.

Microbiology

Short-term catheterization

E.Coli is the most common isolated organism with about third of all isolates, other isolates include Klebsiella spp, Serratia spp, Citrobacter spp, P.aeruginosa and gram positive cocci(coagulase negative)like staphylococci and Enterococci.

Long-term catheterization

It is usually polymicrobial, and in addition to the previous organisms, P.mirabilis, Morganella morganii and P.stuartii are also common.

CA-UTI risk reduction

Avoidance of Unnecessary Catheterization

• Indications for indwelling catheters are:30-120-121

1-Significant urinary retention. 2-Urinary incontinence if other less invasive measures fail or contraindicated. 3-Monitoring output for critically ill patients. 4-Anesthetized patients undergoing certain surgical procedures(urological or gynecological).

• Using educational methods through hospital or institution guidelines and spreadsheets for indication and contraindication has reduced the inappropriate use of catheters and thereby the rate of CA-UTI. 128
• For post-operation patients, a portable ultrasound for bladder has proven to be accurate assessment for bladder volumes, thus reducing unnecessary catheterization. 131-130