Chronic Catheter Associated Complications and Catheter-Associated Urinary Tract Infection

Abstract

Catheter-associated urinary tract infection (CAUTI) is common, costly, and is associated with significant patient morbidity, particularly with chronic indwelling urinary catheters. There has been an increased focus on the prevention of CAUTI since the Centers for Medicare and Medicaid Services instituted nonreimbursement for CAUTI. Interpretation of many studies of CAUTI is impeded by the failure to distinguish between symptomatic and asymptomatic bacteriuria. Consensus guidelines for the diagnosis, prevention, and treatment of CAUTI have been published by multiple organizations. However, a single, evidence-based approach to the diagnosis of urinary tract infection does not exist. Biofilms play a unique role in the pathogenesis of CAUTI and are associated with pathogens with a high propensity toward multidrug resistant organisms. Duration of urinary catheterization is the most important risk factor for CAUTI. Avoiding placement of indwelling catheters and promoting early removal of the catheter when appropriate are the most effective interventions to prevent CAUTI. Many aspects of the management of CAUTI merit further study. Practical strategies are needed to ensure effective use of proven infection prevention and ameliorate the burden of disease associated with indwelling urinary catheterization.