Indwelling Urinary Catheter Use Research Articles

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department.

Indwelling urinary catheters (IUCs) are placed frequently in older adults (age ≥ 65 years) in the emergency department (ED) and carry significant risks. The authors developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in elders in the ED. A comprehensive, evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups. It was implemented at a university-based medical center with a 20-minute scripted slide presentation. Written surveys were administered before, after, and at 6 months to assess providers' baseline practice and the protocol's effects. Surveys included asking providers for IUC management decisions in 25 unique clinical scenarios. Rates of IUC placement and catheter-associated urinary tract infections (CAUTIs) were compared in ED older adult patients admitted to the hospital in the 6 months before and after protocol implementation. A total of 111 ED providers participated in the all three surveys. Immediately after protocol introduction, providers anticipated that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 81% felt the protocol had changed their practice, and 39% reported frequently referencing the protocol. In the clinical vignettes, ED providers correctly identified the appropriate approach for IUC placement in 63% of cases at baseline with an increase of 22% (95% confidence interval [CI] = 19% to 25%) postintervention and an increase of 8% (95% CI = 6% to 12%) between baseline and 6 months. An absolute reduction in the use of IUCs of 3.5% (p < 0.001) for older adults admitted to the hospital was observed after implementation of the protocol. There were three CAUTIs attributable to the ED in the 6 months prior to implementation and none in the 6 months after. This comprehensive, evidence-based clinical protocol was well received by participants and was associated with a sustained change in self-reported practice, as supported by a reduction in IUC placement in admitted older adults and a reduction in CAUTIs attributable to the ED for this vulnerable population over the 6-month study period.

Bladder Management With Epidural Anesthesia During Labor: A Randomized Controlled Trial.

Many labor nurses routinely include continuous urinary catheterization (CC) as part of their standard care for women who receive intrapartum epidural anesthesia, to prevent urinary retention, thought to delay fetal descent. Recent studies question use of CCs during labor, as they may predispose patients to urinary tract infections (UTIs), even though the catheters are in place for a relatively short period of time. The objective of this study was to determine the influence of CCs versus intermittent catheters (ICs) (only as needed) on the duration of second stage of labor and the incidence of postpartum UTIs. Randomized controlled trial. English-speaking low-risk nulliparous women ≥37 weeks gestation with a single fetus in a vertex presentation who requested an epidural were eligible for participation. Prior to epidural placement, cervical status was documented, women were encouraged to void, and then women were randomized to receive either CC or IC as the method for urinary bladder management for the duration of the first stage of labor. Final sample size included 123 participants; 55 in the CC group and 68 in the IC group. No differences were noted in length of second stage labor, and the overall incidence of UTIs in both groups was low. There was a significantly increased likelihood of cesarean birth in women who had CC (P < .01) when compared to women who had IC. The overall cesarean rate in the CC group was 27.3%, versus 10.3% in the IC group. Intermittent catheterization only as needed appears to be best practice for bladder management for laboring women with an epidural. There was a significantly higher rate of cesarean birth among women in the CC group. The relationship between route of birth and use of continuous indwelling urinary catheters for women in labor with epidurals for pain relief needs more study.

Does our bundle stack up! Innovative nurse-led changes for preventing catheter-associated urinary tract infection (CAUTI)

Abstract Introduction The aim of this project was to develop and implement an innovative nurse-led model of care in the use and management of indwelling urinary catheters (IUC) utilising evidence-based ‘bundle interventions' to reduce the incidence of catheter-associated urinary tract infections (CAUTI). Design and method A pre and post intervention study designed to progress in three phases was conducted in the orthopaedic ward and urology ward of a large tertiary referral facility. Phase one involved a clinical data collection pre intervention on all inpatients receiving an IUC over a 3-month period from February to April 2013. A staff survey assessed knowledge and skills and an evidence-based care bundle, nurse-led protocols, and education resources were developed through collaboration with clinicians. Phase two involved implementation and Phase three was an evaluation with the primary outcome targets being reduced IUC usage, days IUC in situ and incidence of CAUTI. Results Pre audit data revealed a high rate of IUC use: 31% of all inpatients in the orthopaedic ward and 25% in the urology ward. Compliance with current guidelines was inconsistent and documentation related to IUCs was poor. Overall CAUTI rate was relatively low at 2.2% of all patients with an IUC and was higher in the orthopaedic ward. Conclusion The development of a systematic and standardised approach to IUC care for inpatients using bundle care interventions will potentially reduce IUC use, provide a clear pathway for nurse-initiated IUC removal and reduce the incidence of catheter-associated urinary tract infections (CAUTI).

Provider perspectives on the use of indwelling urinary catheters in older adults in emergency department settings: Developing a novel clinical protocol

Indwelling urinary catheters (IUCs) are commonly placed in older adult (aged ≥ 65 years) patients in emergency department (ED) settings, often for inappropriate indications. The aim of our qualitative study was to explore ED provider knowledge, attitudes, and practice patterns surrounding use of IUCs in older adult patients in the ED setting, to better guide development of a clinical protocol. We conducted 4 focus groups with 38 participants at a large academic medical center. Each focus group was conducted with a single ED provider type: attending physicians, residents, physician assistants, or nurses. Focus groups used a semistructured format, ranging in duration from 23-33 minutes. The sessions were audiorecorded, fully transcribed, and data were coded and analyzed to identify themes. Participants reported believing that IUCs are overutilized in ED settings, confirming that IUCs are infrequently removed once placed and often inserted for staff convenience. Participants reported that current clinical decision making about IUC placement varies widely; yetall acknowledged the known risks for patient safety and willingness to adopt a clinical protocol to standardize practice. Focus groups were a critical component for the development of a user-friendly protocol, identifying 10 key elements for successful implementation and 11 potential barriers. An evidence-based clinical protocol guiding ED providers in appropriate placement and management of IUCs in older adults would be welcomed.

215 A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department: Implementation and Impact Assessment

Indwelling urinary catheters (IUCs) are placed frequently in older adults (age ≥65) in the emergency department (ED) and carry significant risks. As highlighted by the Choosing Wisely campaign, this is an intervention that should be considered judiciously. To implement and assess the impact of a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in older adults in the ED. We developed a comprehensive, evidence-based clinical protocol and implemented it at a large, urban, academic medical center with over 67,000 adult patient visits annually. We introduced the protocol to multiple EM providers, including attendings, residents, mid-levels, and nurses with a 20-minute scripted slide presentation. Pocket cards were distributed and the protocol was displayed in the ED. Written surveys were administered before the intervention, immediately after, and at 6-months to assess providers’ baseline knowledge, attitudes, and practices, as well as the protocol’s long-term impact. Surveys included asking providers for IUC management decisions for 25 unique clinical scenarios. To objectively assess the clinical impact of the protocol, we retrospectively compared rates of IUC placement in this ED in patients aged ≥65 in the 6 months before (January 1, 2013 to June 30, 2013) and 6 months after (September 1, 2013 to February 28, 2014) implementation of the protocol. Of the 125 EM providers participating in the implementation phase of this study, 112 (90%) completed 6-month follow-up. Immediately after protocol introduction, 98% of the participants reported that the intervention made them more comfortable with the appropriate indications for IUC placement; 87% reported anticipating that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 80% felt that the protocol had changed their practice and 38% reported frequently referencing the protocol. In the clinical vignettes, ED providers correctly identified the appropriate approach for IUC placement in 33% of cases pre-intervention compared to 54% immediately post-intervention and 44% at 6 months (P<.001). Four thousand nine hundred sixty-seven (61%) of the 8,147 older adults evaluated in the ED during the 6 months prior to implementation were admitted. Of those admitted, 935 (18.8%) received an IUC in the ED. In the 6 months after implementation, 4,781 (59%) of the 8,119 older adults evaluated in the ED were admitted, with 731 (15.3%) having received an IUC in the ED. This represents a relative risk reduction of 18.6% (P<.001) for ED use of IUCs in this population. Introduction of this comprehensive, evidence-based clinical protocol has been well received by ED providers. It has led to sustained self-reported practice change and significant reduction in overall IUC placement in older adults in our ED who were admitted to the hospital. Our next steps include evaluating whether this reduction has concomitantly increased the proportion of IUCs placed in the ED for appropriate indications, and to assess whether it has led to fewer catheter-associated urinary tract infections during hospital admission and improved patient-centered outcomes.

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.

Quality Gaps in Documenting Urinary Catheter Use and Infectious Outcomes

To describe the frequency of use of all types of urinary catheters, including but not limited to indwelling catheters, as well as positive cultures associated with the various types. We also determined the accuracy of catheter-days reporting at our institution. Prospective, observational trial based on patient-level review of the electronic medical record. Chart review was compared with standard methods of catheter surveillance and reporting by infection control personnel. Ten internal medicine and 5 long-term care wards in 2 tertiary care Veterans Affairs hospitals in Texas from July 2010 through June 2011. The study included 7,866 inpatients. Measurements included patient bed-days; days of use of indwelling, external, suprapubic, and intermittent urinary catheters; number of urine cultures obtained and culture results; and infection control reports of indwelling catheter-days. We observed 7,866 inpatients with 128,267 bed-days on acute medicine and extended care wards during the study. A urinary catheter was used on 36.9% of the total bed-days observed. Acute medicine wards collected more urine cultures per 1,000 bed-days than did the extended care wards (75.9 and 10.4 cultures per 1,000 bed-days, respectively; P<.001). Catheter-days were divided among indwelling-catheter-days (47.8%), external-catheter-days (48.4%), and other (intermittent- and suprapubic-catheter-days, 3.8%). External catheters contributed to 376 (37.3%) of the 1,009 catheter-associated positive urine cultures. Urinary-catheter-days reported to the infection control department missed 20.1% of the actual days of indwelling catheter use, whereas 12.0% of their reported catheter-days were false. Urinary catheter use was extremely common. External catheters accounted for a large portion of catheter-associated bacteriuria, and standard practices for tracking urinary-catheter-days were unreliable. ClinicalTrials.gov identifier: NCT01052545.

Optimizing Urinary Catheter Utilization to Improve Patient Outcomes

Indwelling urinary catheter (UC) use is associated with decreased mobility, patient discomfort and an increased risk for catheter-associated urinary tract infection (CAUTI). Inappropriate catheter use has been reported to range from 21% to greater than 50%. This project aimed to eliminate inappropriate catheter use, optimize duration, and ultimately reduce CAUTI.

Reducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative

This quality-improvement project aimed to evaluate the effectiveness of implementing multidisciplinary education and deploying utilization tools aimed at reducing the inappropriate insertion of indwelling urinary catheters (IUCs) in the emergency department. Literature supports the use of decision support tools and education as proven techniques to reduce IUC use. Few studies have implemented a multidisciplinary approach involving the use of focus groups to understand the thought processes behind deciding to place an IUC. Focus groups were used to understand the current practice for inserting an IUC in the emergency department. These data were then used to create a nursing-based IUC decision support tool and educational presentation regarding appropriate uses for IUCs. Live, in-person education sessions were given to emergency nurses, emergency medical technicians, physicians, and residents; in addition, electronic education was assigned to all emergency nurses and technicians. Seventy-eight percent of ED staff received some form of education regarding appropriate IUC insertion criteria. Physicians and residents also received an in-person presentation on the topic. A survey was sent to all emergency nurses and emergency medical technicians to assess actual practice changes. In addition, an IUC utilization and appropriateness audit was completed before and immediately after the interventions. The project resulted in a 25% decrease in the proportion of patients admitted to inpatient status with IUCs placed in the emergency department and a 9% decrease in the inappropriate use of IUCs. Staff surveys after education showed that staff members were more likely to document the reason for placing an IUC and to use alternatives to IUCs. The potential risks associated with IUCs often go overlooked by direct-care staff members. Educating staff and creating new standards and utilization tools have often been used to decrease the initial insertion of IUCs and to improve recognition of appropriate removal of IUCs. Using direct feedback from staff to develop the interventions led to a reduction in IUC insertions in the emergency department in the short-term, but long-term changes were not seen. The project results suggest that incorporating staff into the decision making and implementation will lead to long-term acquisition of knowledge and longer-term results. Ongoing regularly scheduled education refreshers need to be assessed for their potential to affect long-term change.

Relationship between indwelling urinary catheter use and urinary tract infection after total hip arthroplasty

Relationship between indwelling urinary catheter use and urinary tract infection after total hip arthroplasty

Infecciones asociadas a dispositivos para drenaje de las vías urinarias. Infecciones del tracto genital relacionadas con los dispositivos protésicos

Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.

Preventing IUC infections in Tanzanian patients; nurses’ knowledge, clinical practice and patients’ views

AbstractNosocomial infections related to indwelling urinary catheters (IUC) are a worldwide problem. While this is true in areas of the globe where care facilities are optimal, it is even more the case that in countries where care conditions are compromised or when practice is lacking a substantial knowledge base. The primary aim of this study was to investigate nurses’ knowledge and clinical practise regarding care of patients with IUC in preventing nosocomial infections in four hospitals in Tanzania. Additionally, the study investigated patients’ views about received care relating to the presence of an IUC. Registered and enrolled nurses (n = 135) working in four hospitals in Dar‐es‐Salaam municipality completed a questionnaire about IUC procedures. Four nurse students performed bedside observations of nurses (n = 127) on the care for patients with IUC. Sixty patients were interviewed about their views of the care given in relation to IUC. The nurses’ overall knowledge was good, but there was a discrepancy between knowledge and clinical practice. Hand washing prior to care for patients with IUC was poor due to lack of water and soap. Half of the patients experienced problems; haematuria, offensive smell, pus around the catheter and swelling of the scrotum in male patients. Patients expressed frustration regarding the care of IUC. There was a shortage of trained hospital staff, shortage of beds to the extent that patients had to share beds and appropriate equipment was not available. Although the nurses’ knowledge in IUC care was relatively good, the nursing care for patients with IUC in the studied hospitals ought to be improved. This can be done by developing evidence‐based, culturally congruent guidelines for assurance of quality care. Many of the problems that were considered to increase the risk of nosocomial infections were identified as being related to the logistics of the wards and lack of staff. Therefore, on the strength of these findings, it is recommended that unnecessary use of IUC should be avoided particularly where weak infrastructure has been identified.

The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care

BackgroundThe use of indwelling urinary catheters (IUCs) is thought to be the most significant risk factor for developing nosocomial urinary tract infections (UTIs). However, it is unclear how many elderly patients have preexisting bacteriuria prior to IUC placement. The purpose of this study was to determine 1) the frequency and appropriateness of IUC use in the Emergency Department (ED) in elderly patients admitted to our acute care hospital, 2) the percentage of elderly patients with an IUC who were discharged from the hospital with a diagnosis of UTI, 3) the percentage of patients with IUCs who were diagnosed and treated for UTI in the ED or who had admission bacteriuria ≥105 organisms/ml indicating preexisting UTI, and 4) the percentage of patients with no indication of UTI on admission who had inappropriately placed IUCs and subsequently were diagnosed with a UTI.MethodsRetrospective chart review. Chi square used to test significance of differences in proportions.ResultsSeventy three percent of patients who received an IUC in the ED were elderly (≥65 years old). During the study period, 277 elderly patients received an IUC prior to admission. Of these, 77 (28%) were diagnosed with UTI during their hospitalization. Fifty three (69%) of those diagnosed with a UTI by discharge either had the UTI diagnosed in the ED or had bacteriuria ≥105 organisms/ml prior to IUC placement. Of the 24 elderly patients who developed a catheter-associated UTI (i.e., 9% of the elderly population who received an IUC), 11 of the IUCs were placed inappropriately. Thus, 4% of elderly patients with no indication of UTI on admission who received an inappropriate IUC in the ED had a primary or secondary diagnosis of UTI by discharge. The overall rate of nosocomial UTI due to an inappropriately placed IUC was the same in males and females.ConclusionThis study indicates that the strong association between IUC use and UTI may be partly explained by the high prevalence of preexisting UTI prior to IUC placement. Further prospective studies are needed to clarify the true risk vs benefit ratio for IUC use in acutely ill elderly patients.

Reducing Foley Catheter Device Days in an Intensive Care Unit

The prolonged use of indwelling urinary catheters can lead to many complications, the most prevalent being urinary tract infections. These hospital-acquired infections can increase hospital costs, length of stay, and mortality rates. Evidence-based guidelines for the prevention of urinary tract infections are compared and discussed. Minimizing indwelling urinary catheter use is well-recognized in the literature to reduce the risk of these infections. To decrease the incidence of catheter-associated urinary tract infections, the staff of a 22-bed, mixed medical, surgical, and trauma intensive care unit focused on reducing the number of foley catheter device days. A multidisciplinary team was convened to create an evidence-based plan. Staff nurses were engaged in the development and implementation of the plan. Criteria-based foley catheter guidelines, a decision-making algorithm, and a daily checklist were implemented that led to a significant reduction in foley catheter device days and a decrease in catheter-associated urinary tract infections.

Indwelling catheter use in home care: elderly, aged 65+, in 11 different countries in Europe

To describe possible differences/patterns in the use of indwelling urinary catheters (IUC) in Europe. A prospective, population-based, assessment study. The target population was 4,455 (random sample of 405 from each of 11 countries) aged 65+ receiving home care. The clients were assessed by using the Resident Assessment Instrument MDS-HC; epidemiological and medical characteristics of clients and service utilisation were recorded. The frequency of use of IUC related to the patients' activities of daily living (ADL) and cognitive functioning. The sample consisted of 4,010 informants: 74% female, with mean age 82.3 +/-7.3 years; men 80.9 +/-7.5 years and female 82.8 +/-7.3 years. A total of 216 (5.4%) clients were using IUC. In Italy 23% were using a catheter compared with 0% in The Netherlands. Catheter use was more common in men than in women (11.5% versus 3.3%). Use of IUC was significantly correlated to certain diseases and symptoms and increase in care burden and formal services. Twenty-six per cent of the informants with indwelling catheters scored three or more on a hierarchical ADL scale (0-6). The clients using IUC in the Nordic countries were less dependent on care than in the other European countries. Models built on multivariate analysis explained 37% of the use of IUC. Tradition and attitudes may explain the differences between the sites. Catheter use is associated with formal or family care burden. The need for nursing home placement ought to be considered in some cases. A stricter criterion for using IUC may be considered in the southern European countries.

A Collaborative Practice Model Reduces Indwelling Urinary Catheter Use and Risk for Nosocomial Urinary Tract Infections

ABSTRACT Objectives: (1) Decrease use of indwelling urinary catheters. (2) Limit the number of overall catheter days. Design: Prospective cohort study. Population, Sample, Setting, and Years: Patients requiring indwelling urinary catheters admitted to general medical units at Yale‐New Haven Hospital were included. Patients with chronic catheters were excluded. Data were collected in spring 2002 and repeated in spring 2003. Intervention and Outcome: A physician–nurse protocol was developed to allow physicians to select, via a computerized order‐entry system, one the following options: (1) discontinue catheter, (2) maintain catheter for 48 hours, or (3) maintain chronic device. The protocol permits nurses to independently remove urinary catheters for patients meeting established criteria. Outcome measures included calculated device days (CDD), calculated infection rates (CIR), and device utilization ratio (DUR). Methods: During 53 consecutive days in 2002, all patients (n = 883) were assessed for occurrence, duration, and appropriateness of catheter use. Patients with catheters were assessed for infection. This procedure was repeated 1 year later postintervention (n = 894). Data were analyzed using descriptive and inferential statistics. Findings: Compared to baseline, there was a 51% reduction in catheter use post intervention (164 versus 81) among all four patient units. Although the outcome variables were not statistically significant, they were clinically significant. The CDD declined from 892 to 521 days, a 42% reduction, while the CIR decreased from 36 of 1000 to 19 of 1000 patient days (47% reduction). The DUR (device days/all patient days) fell from 16% to 10%. One unit demonstrated a statistically significant decrease in CIR (p &lt; 0.05). Conclusions: Results of this study demonstrate that use of a collaborative practice model reduces indwelling urinary catheter use and risk for nosocomial urinary tract infections. Implications: This protocol will heighten clinicians' awareness of the appropriate use of catheters and parameters to guide decision‐making regarding their removal.

Prevention of urinary tract infection in patients with spinal cord injury--a microbiological review.

The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with significant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to differences in definitions of UTI, studies on groups using different urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. The complications due to UTI and the difficulties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may benefit from the use of antiseptics or antibiotics is urgently required. Continued research into different methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.

The epidemiology and risk factors for nosocomial catheter-associated bacteriuria caused by coagulase-negative staphylococci.

Studies of the risk factors for bacteriuria associated with the use of temporary indwelling urinary catheters have focused on gram-negative bacilli and enterococci, the predominant causes of nosocomial urinary tract infection. During a prospective study of 747 catheterized patients, bacteriuria with greater than or equal to 1,000 bacteria/mL were found in 96 patients. Coagulase-negative staphylococci (CNS) accounted for 19% of the episodes of bacteriuria, and S. epidermidis was the most frequent species of CNS. Significant risk factors for bacteriuria were a positive meatal culture for CNS, non-surgical illness, and no antibiotic therapy during catheterization. In contrast to the results of this and earlier studies that females were at greater risk factor for catheter-associated bacteriuria with gram-negative bacilli and enterococci, this was not a risk factor for acquisition of CNS. Possibly this is due to the more similar prevalence of meatal colonization with CNS of males and females compared to the striking difference in prevalence of meatal colonization with gram-negative bacilli and/or enterococci of males and females.