Development Of Catheter-associated Urinary Tract Infections Research Articles

Catheter-associated urinary tract infection and urinary tract abnormalities in young children: A retrospective study

IntroductionStudies investigating the role of urinary tract abnormalities in the development of catheter-associated urinary tract infections (CAUTI) in young children are limited. Thus, in the present study, we aimed to determine whether there is an association between CAUTI and urinary tract abnormalities. MethodsWe performed abdominal imaging studies on all patients aged <6 years with CAUTI admitted to the pediatric intensive care units (PICU) and high care unit (HCU) at Keio university or Fukuoka Children's Hospital from April 1, 2018 to July 31, 2022. Among 40 children who developed CAUTI, 13 (33 %) had abnormal urogenital images. Further, two case-control studies were conducted before and after propensity score matching, and the groups were compared using multivariable logistic regression models to analyze the effects of various factors on CAUTI development. ResultsIn the multivariate logistic regression models, abnormal urogenital images (OR 5.30 [95 % CI, 2.40–11.7] and OR 3.44 [95 % CI, 1.16–9.93]) and duration of catheterization >10 days (OR 2.76 [95 % CI, 1.28–5.96] and OR 3.44 [95 % CI, 1.16–9.93]) were found to be significantly associated with development of CAUTI, both before (39 cases, 459 controls) and after propensity score matching (36 cases, 72 controls). Further, CAUTI in young children in the PICU or HCU was significantly associated with imaging abnormalities of the urinary tract. ConclusionsThese results suggest that not only the presence of catheters, but also urinary tract malformations may contribute to the development of CAUTI in young children.

A Study of Clinical and Economical Burden Imposed by Catheter Associated Urinary Tract Infection in a Tertiary Care Teaching Hospital

Background and Objectives: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care-associated infections worldwide. Determination of the clinical and financial burden of CAUTI is of critical importance for all stakeholders for rational and fair allocation of resources. Materials and Methods: This study was a prospective observational study. The microbiological profile, antimicrobial usage, length of hospitalization (LOH), and cost of antimicrobial therapy of the patients diagnosed to have CAUTI were assessed. Data were expressed as mean ± standard deviation and range. Simple regression was used to find an association between the duration of catheterization and the development of CAUTI, one-way ANOVA was used to analyze the organism-specific differences in the above parameters. Results and Interpretation: One hundred and seventy-two patients with CAUTI were identified during the study period. The mean number of days from the insertion of the catheter to the development of the first symptom of CAUTI was 5.19 ± 2.08 days with a range of 2–14 days. Escherichia coli spp. was the most common isolate in 62% of patients. 81.39% of isolates were multidrug resistant. There was no significant difference observed in the days of therapy or length of therapy or LOH in different patients of CAUTI based on the causative organism; however, the cost of acquisition of antimicrobial therapy was found to be significantly different among the different microorganisms. Conclusion: Increasing prevalence of multidrug-resistant organisms has made the management of CAUTIs considerably more challenging. Implementation of optimum preventive measures and antimicrobial stewardship practices is essential.

Bacteriology and Antibiotic Sensitivity Patterns of Urine in Urology Patients with Indwelling Urinary Catheters at the University Teaching Hospital in Lusaka, Zambia

Introduction: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in hospitals worldwide, and the incidence has been reported to be up to 35%. The growing antibiotic resistance amongst the uropathogens isolated from CAUTI makes it challenging to manage. In Zambia, prolonged catheter use is a burden, particularly in patients awaiting definitive surgery, the elderly and the socioeconomically challenged. Bacterial colonisation following catheterisation is inevitable, with reports estimating the risk to be around 5-10% per day. By day 10, virtually all patients with urinary tract instrumentation have healthcare-associated UTI, with the duration of catheterisation the most important factor. Methodology: The study was a descriptive cross-sectional study conducted at UTH over a period of 10 months from July 2015 to May 2016. The cases were inpatients and outpatients with indwelling catheters in situ for not less than three calendar days. Simple random sampling was used to select candidates who were inpatients awaiting definitive surgery and outpatients in the same category as they attended clinics. Data collection and collection of specimens were done by the principal investigator, which was analysed by the microbiologist based at the UTH microbiology laboratory. The patients were recruited at one point, and the data collection exercise employed a questionnaire to collect socioeconomic demography and clinical information. The variables were collected using the data collection sheet for each participant. The data was then entered into SPSS software to clean and analyse data. The categorical variables were presented as proportions. The main concerns arising during specimen collection were the duration between the time of specimen collection and transfer to and processing at the main laboratory, which was kept within one hour. Specimens received within two hours of the collection were accepted. Results: A total of 228 patients were enrolled from both outpatient and inpatient departments. Approximately 75% yielded growth of bacteria, and 25.0% were negative. The pure growth yielded Klebsiella Pneumoniae 28.0% and E. coli 25.2%, as the most isolated pathogens. The antibiotic susceptibility testing revealed the highest resistance of the above isolates to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin, levofloxacin, and borderline with cotrimoxazole. The organisms were least resistant to amikacin, imipenem, nitrofurantoin, and gentamycin. Acetinobacter and Citrobacter species were also highly resistant to the above drugs with nitrofurantoin in addition but least resistant to ampicillin. Conclusion: The study revealed a high prevalence of CAUTI in the urology section of the UTH, and practices such as poor hand hygiene, open catheter drainage, non-aseptic methods of catheter insertion and poor catheter care are possible contributing factors. There is an association between the insertion of indwelling catheters and subsequent development of CAUTI, and the strongest factors noted are the size of the catheters used and the patient's level of education. High resistance to antibiotics to many organisms of concern was noted.

Quality Initiative to Reduce Catheter-Associated Urinary Tract Infections Using Cleansing Cloths With a Standardized Method

Background: Catheter-associated urinary tract infections (CAUTIs) account for &gt;15% of hospital-acquired infections, resulting in increased length of stay and costs. Consequently, methods to improve indwelling urinary catheter (IUC) care and maintenance are warranted to reduce the risk of hospital-acquired CAUTIs. This study was a prospective quality improvement (QI) project to reduce CAUTIs using prepackaged cloths (ReadyCleanse by Medline Industries) and a simple, standardized cleaning process for care and maintenance of IUCs. Methods: This study is an ongoing QI project at NorthShore University HealthSystem, a 4-hospital system located north of Chicago, Illinois, with 750 beds and ∼64,000 annual admissions. The study consists of a 1.5-month staff training on proper product use (phase 1), followed by an intervention using the cloths for IUC care (phase 2). Each package contains 5 individual cloths corresponding to a simple, 5-step, cleansing protocol. IUC care and maintenance are performed twice daily on a routine basis and after each incontinent episode. Beginning July 2018, current practice (soap and wash cloth) was replaced with the ReadyCleanse cloths, and on August 1, 2018, data collection began. Adult patients admitted at all 4 NorthShore Hospitals with an IUC for &gt;24 hours are enrolled in the study. From patient electronic health records, we collected patient demographics, reason for IUC insertion, days of catheter use, and development of CAUTI (according to the NHSN definition). During the intervention, observations of compliance and performance of catheter care were also performed. For the analysis described here, results for the first 14 months of the study were compared to CAUTI numbers from the 14-month period prior to the start of the study (February 2017–March 2018); the data presented represent ∼50% of the planned data collection. Results: As of September 30, 2019, 4,969 patients were prospectively enrolled in the study: 1,491 patients from hospital A, 1,451 from hospital B, 1,091 from hospital C, and 936 from hospital D. Patient demographics for the study cohort were 47% female, with a median age of 77 years and an average of 3.9 catheter days per patient. Systemwide, observational audits for compliance using the cloths averaged 95%. Upon completion of study month 14, 22 CAUTIs had been identified, compared to 26 CAUTIs for the comparison period, indicating a 15% reduction. Conclusion: Implementation of this simple, standardized alternative for IUC care is feasible on a large scale and may have potential for reducing CAUTI rates.Funding: Medline Industries supported this study.Disclosures: None

High-resolution imaging reveals microbial biofilms on patient urinary catheters despite antibiotic administration.

Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity worldwide, as they account for 40% of all hospital-associated infections. Microbial biofilm formation on urinary catheters (UCs) limits antibiotic efficacy, making CAUTI extremely difficult to treat. To gain insight into the spatiotemporal microbe interactions on the catheter surface we sought to determine how the presence or absence of bacteriuria prior to catheterization affects the organism that ultimately forms a biofilm on the UC and how long after catheterization they emerge. Thirty UCs were collected from patients who received a urine culture prior to catheterization, a UC, and antibiotics as part of standard of care. Immunofluorescence imaging and scanning electron microscopy were used to visualize patient UCs. Most patients did not have bacteria in their urine (based on standard urinalysis) prior to catheterization, yet microbes were detected on the majority of UCs, even with dwell times of < 3days. The most frequently identified microbes were Staphylococcus epidermidis, Enterococcus faecalis, and Escherichia coli. This study indicates that despite patients having negative urine cultures and receiving antibiotics prior to catheter placement, microbes, including uropathogens associated with causing CAUTI, could be readily detected on UCs with short dwell times. This suggests that a potential microbial catheter reservoir can form soon after placement, even in the presence of antibiotics, which may serve to facilitate the development of CAUTI. Thus, removing and/or replacing UCs as soon as possible is of critical importance to reduce the risk of developing CAUTI.

Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol.

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

Reducing urinary catheter use: a protocol for a mixed methods evaluation of an electronic reminder system in hospitalised patients in Australia

IntroductionDespite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. Prolonged urinary catheterisation is the main risk factor for development of CAUTIs; hence,...

A study of risk factors for catheter associated urinary tract infection

Background: Catheter associated urinary tract infections (CAUTIs) are the most common causes of UTIs in postoperative cases. Many risk factors are associated with its incidence. The present study was conducted with the aim to determine the related risk factors and to identify the causative agents contributing to the urinary tract infection.Methods: This prospective study was conducted on 210 patients meeting the requirements of inclusion criteria during September 2012 to February 2014. Detailed history of the patients was recorded. Urine culture was done at different time intervals to identify the causative agent suggestive to CAUTI. Univariate analyses of the association of each variable with CAUTI and multivariable logistic regression were done to predict CAUTI outcome.Results: The mean age of study participants was 51.61 years. Among them 141 were males and 69 were female patients. On univariate analysis purpose for urine catheterization, place of catheterization, breach in the closed system of drainage, duration of catheterization, hemoglobin value less than 10, raised renal parameters with serum creatinine more than 1.5 were all significantly associated with development of CAUTI (p value 0.000). Sex of the patient (p value 0.279) and catheter size (p value 0.279) was not found to have a significant correlation with increased risk of CAUTI. On multivariate analysis, age, catheter size, diabetes, duration of catheterization, a breach in the closed system of catheter drainage and sex were found to be the significant risk factors associated with CAUTI (p&lt;0.05).Conclusion: An understanding of the risk factors in development of CAUTI, significantly helps in reducing the additional burden on the health care system. Measures such as shortening the duration of catheterization, strict control of diabetes and sterile precautions in insertion and maintenance of indwelling catheters can help in prevention CAUTI.

Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study.

To evaluate the frequency and appropriateness of indwelling urinary catheters (IUC) use and the incidence of catheter-associated urinary tract infections (CA-UTI), and explore the risk factors for CA-UTI in hospitals as a whole, we conducted a study. This study was divided into two parts; a point-prevalence study on Dec 12th 2012 and a prospective cohort study from Dec 13th 2012 to Jan 9th 2013 were performed in six hospitals in Korea. All hospitalized patients with newly-placed IUCs were enrolled and monitored weekly for 28 days after IUC placement. In the point-prevalence study, the IUCs were present in median 14.9/100 hospitalized patients (1Q 14, 3Q 16) across the six hospitals. In the prospective cohort study, the median IUC-days per patient was 5 (1Q 3, 3Q 10) and the median CA-UTI prevalence per 1,000 catheter days was 1.9 (1Q 0.7, 3Q 3.8) with significant inter-hospital variation. The proportion of patients with inappropriate IUC maintenance increased with number of IUC-days (8.5% on day 7, 9.4% on day 14, 16.3% on day 21, and 23.1% on day 28). Urinary output monitoring (23/36, 63.9%) was the most common indication for inappropriate use after 1 week of ICU placement. In multivariate analysis, IUC-days was significantly associated with the development of CA-UTI (odds ratio 1.122, 95% confidence interval 1.074–1.173, P< 0.001). IUC-days and CA-UTI rates vary between hospitals. IUC-days is a risk factor for CA-UTI, and is correlated with inappropriate use.

Next-Science: A Novel Antimicrobial Agent that Inhibits Biofilm Development by Escherichia coli Clinical Isolates on Urinary Tract Catheters

Catheter-associated urinary tract infections (CAUTI) constitute about 40% of health-care associated infections in the United States. It is estimated that about 15% to 25% of hospitalized patients receive a urethral catheter at some point during hospitalization predisposing them to the development of CAUTI. Pathogenic bacteria colonize the surface of the catheter and develop highly resistant structures termed biofilms which protect them from the effects of diverse antibiotics. Escherichia coli are among the main causative agents of CAUTI. Due to the emergence of antibiotic resistant strains, it is critical to develop new novel antimicrobial agents. We recently showed that a novel anti-biofilm agent, Next Science, inhibited biofilm development by wound pathogens. In this study, we tried to determine if treating urinary tract catheters (UTC) with NS prevents the development if E. coli biofilms. Three types of UTCs were cut into small pieces that were treated with NS. Biofilm development by an E. coli laboratory strain and several E. coli clinical isolates on treated and untreated pieces was accomplished using the microtiter plate assay. Biofilms developed on inner and outer surfaces of the catheters were quantified by determining the number of microorganisms (colony forming units) on each piece and visualized using confocal laser scanning microscopy (CLSM). In comparison with untreated catheters, all three types of NS-treated catheters prevented biofilm development by tested E. coli strains. In addition, CLSM demonstrated the presence of E. coli biofilms on the inner and outer surfaces of the untreated but not treated catheters. Our results suggest that NS is a novel antimicrobial treatment to prevent biofilm development by pathogenic E. coli strains on UTCs.

Impact of an aseptic procedure for breaking the integrity of the urinary drainage system on the development of catheter-associated urinary tract infections in the intensive care unit

Catheter associated urinary tract infections (CAUTI) are a common complication in the hospital, especially in intensive care units (ICU). These infections are directly linked to the use of an indwelling urinary catheter. One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice. The primary purpose of this observational study was to assess if there is a relationship between CAUTI incidence and breaking the closed drainage system using an aseptic procedure. A process improvement effort was developed to ensure an aseptic technique was utilised when there was a need to break the integrity of the urinary drainage system. Because this was a new practice and not supported by the Centres for Disease Control (CDC) recommendations, this change in practice was evaluated as an observational study. In an eight month period there were 53 documented breaks in the urinary drainage system. There were 28 total cases of CAUTI overall during this same time period. Only four patients with a system break developed a CAUTI (7.5%). In almost 93% of the patients where aseptic technique was used for breaks in the drainage system, there was no occurrence of CAUTI. A follow-up evaluation was performed after a year of this practice in three adult ICUs. During this three month evaluation period, there were 47 documented cases of breaking this system using aseptic technique. Of the patients who had a documented break in their drainage system, none developed subsequent CAUTIs. One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice. This observational study found that utilising an aseptic technique to break the integrity system did not result in an associated increase in CAUTI.

Occurrence of catheter-associated urinary tract infection in critical care units

Background: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection. The etiological agents of which may be varied. Advancing age, debilitation, diabetes mellitus, duration of catheterization are the risk factors. Complications include prostatitis, epididymitis, cystitis, pyelonephritis and septicemia in high-risk patients, adding to hospitalization and morbidity. With this background the present study was undertaken Objectives: (1) To identify microbial pathogens associated with urinary tract infection (UTI) in catheterized patients from Intensive Care Units (ICU) (2) to determine the susceptibility pattern of these isolates to antimicrobial agents (3) to determine the effect of days of catheterization and UTI. Materials and Methods: Consecutive urine samples of 345 catheterized patients admitted in ICUs were included in the study. They were processed by standard microbiological procedures. Isolated organisms were speciated, and antibiotic susceptibility performed as per standard guidelines. Results: From the 345 urine samples of catheterized patients, 205 showed no growth and were found to be sterile. Bacterial growth was seen in 69 patients and fungal growth in 50 patients. Among the bacterial isolates, Escherichia coli were isolated in 39, followed by Klebsiella spp. 14. The other isolates included Pseudomonas spp., Group D streptococci and methicillin-resistant Staphylococcus aureus. In the fungal isolates, Candida glabrata was the most common isolate. High resistance was seen among Klebsiella isolates (nalidixic acid-86% and cefotaxime-86%). Conclusion: Development of CAUTI is common in critically ill patients. Emphasis should be placed on good catheter management and reducing the duration of catheterization rather than prophylaxis in order to reduce the incidence of catheter-related UTI. Culture and susceptibility testing play a vital role in the management if UTI occurs.

Treatment, Management and Prevention of Catheter-associated Urinary Tract Infection

Catheter-associated urinary tract infection (CAUTI) is the most commonly occurring nosocomial infection worldwide, accounting for approximately 40% of all hospital acquired infections. A lot of hospitalized patients undergo insertion of a urinary catheter at some time during their hospital days, and the use of indwelling urinary catheters appears to be increasing. And 80% of urinary tract infection is related to urinary catheterization. Unfortunately, many physicians don' t know about appropriate indications for use of indwelling urethral catheters as well as accurate criteria of CAUTI. Therefore, these could result in a potential source of CAUTI, leading to unnecessary use of antibiotics for treatment of asympk)matic bacteriuria, inducing of resistant organisms. Most CAUTI are derived from the patient's own colonic flora and the catheter predisposes to UTI in several ways. The most important risk factor for the development of CAUTI is the duration of catheterization. The clinician should be aware of two priorities： the catheter system should remain closed and the duration of catheterization should be minimal. While the catheter is in place, systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended, except for some special cases.

A single centre point prevalence survey to determine prevalence of indwelling urinary catheter use and nurse-sensitive indicators for the prevention of infection

Catheter-associated urinary tract infection (CAUTI) is the most common hospital-acquired infection. Key factors influencing the development of CAUTI are indwelling urinary catheter (IUC) insertion duration and nursing management for the prevention of this complication. There is very little evidence describing practice patterns associated with IUC management. The aim of this study was to determine the prevalence of IUC use within a major metropolitan tertiary-referral teaching hospital and to explore nurse-sensitive indicators for the prevention of CAUTI in this context. We conducted a point prevalence survey of IUC use by reviewing every inpatient bed ( n = 696) across two sites over a 2-day period in January 2013. Site 1 comprised ( n = 520, 74.7%) acute inpatient beds and Site 2 ( n = 176, 25.3%) aged care and rehabilitation beds within a single organisation. At the time of the survey 555 (79.7%) beds were occupied. Few patients ( n = 69, 12.4%) had an IUC in situ and a standard Foley's catheter was used for the majority of patients (62, 92.5%). IUC insertion was more prevalent in women over 70 (20, 71.4%) when compared with men (18, 46.2%; χ 2 4.24, P = 0.04). Fourteen nurse-sensitive indicators were assessed and although all indictors were not present for any single patient, drainage system management appeared to be in accordancewith recommended guidelines.Of the patients with an IUC12 (17.4%) had a urine sample sent in the 24 h preceding the survey and 5 (41.6%) of these samples were positive for bacterial colonisation. The prevalence of IUC use in this tertiary teaching hospital was less than that in other centres despite a comparatively older inpatient population in the context of acute care needs. Nurses appear to be proficient in the management of IUC and associated drainage equipment and there is room for interdisciplinary improvement in documentation practices. Future research should test interventions to target appropriate insertion, ongoing need and timely removal of IUC.

Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center

PurposeThis study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms.Materials and MethodsA retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included.ResultsThere were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%).ConclusionsThe factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.