Bacterial Interference in the Urinary Tract

Abstract

Device-related bacterial colonization of the urinary tract and, occasionally, invasive infection are among the most common management problems encountered by infectious diseases consultants. Our usual response is to urge limits on catheter use, avoid treating asymptomatic infection, and anticipate occasional, sometimes life-threatening invasive infections. This advice is generally viewed as being not very helpful. During the 1960s, progress was made with the introduction of closed urinary drainage systems for patients requiring short-term catheterization and intermittent catheter use for patients with neurologically impaired bladders. Otherwise, little has changed in the past quartercentury. We have learned that pyuria accompanying bacteriuria has no particular significance, that even though we may only identify 1 pathogen in a urine culture, multiple organisms are frequently resident in the urinary tract-which is overgrown by the most rapidly grown organism-and that impregnation of catheters with antimicrobial substances has limited (if any) value in the prevention of bacteriuria.