Symptomatic Catheter-associated Urinary Tract Infections Research Articles

CATHETER II: a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter-associated complications in adults living with long-term catheters

ObjectivesDo weekly prophylactic saline or acidic catheter washouts in addition to standard long-term catheter (LTC) care improve the outcomes of adults with LTC compared with standard LTC care only.DesignThree-arm superiority...

COMPREHENSIVE ANALYSIS OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS: RISK FACTORS, MICROBIAL DYNAMICS, AND ANTIMICROBIAL CHALLENGES IN A TERTIARY CARE SETTING

Introduction: Indwelling urinary catheters are frequently employed in medical procedures; yet, they pose a considerable risk, with catheter-associated urinary tract infections (CAUTIs) being a global healthcare challenge. CAUTIs account for 30–40% of nosocomial infections, contributing to heightened morbidity and mortality. Objective: Our objectives included investigating CAUTI incidence, exploring factors contributing to UTI risk, examining the correlation between bacteriuria and symptomatic CAUTI, and recording microbiological profiles and antibiotic sensitivities for insights into microbial dynamics and treatment strategies. Method: We aimed to assess patient and catheter-related factors influencing urinary tract infections (UTIs) in 105 catheterized patients. Results: Among the studied cohort, with an average age of 47.73 years, various catheter sizes were employed, and post-operative catheterization was the predominant indication. Microbial presence in urine samples was detected in 31.4% of cases, with a 21% prevalence of symptomatic UTIs. Diabetes mellitus showed a significant association with increased UTI occurrences (p=0.019). Notably, catheterization outside the operating theater (OT) and prolonged catheterization duration were significantly associated with increased infection rates (p=0.000 and p=0.003, respectively). Despite antibiotic treatment, Escherichia coli remained the most prevalent organism causing infection (17.1%), and antibiotic resistance trends were observed, highlighting the challenges of antimicrobial stewardship. Conclusion: The study emphasizes the importance of preventive measures, such as reducing catheterization duration and meticulous diabetes management, to mitigate the burden of CAUTIs. In conclusion, this study provides valuable insights into the prevalence, risk factors, and microbial dynamics of CAUTIs, urging a shift toward proactive prevention strategies and judicious antibiotic use to enhance patient outcomes and alleviate the strain on health-care resources.

Candida species in catheter associated urinary tract infection in ICU patients at a tertiary care hospital in North India: An observational study

Introduction: Catheter associated urinary tract infection (CAUTI) is most common nosocomial infection which constitutes ~80% of nosocomial urinary tract infections (UTIs). Candida albicans has been most commonly isolated in past but in recent years non-albicans candida has emerged as the more common agent causing UTI in ICU settings. The study aimed to assess the burden of various candida species in symptomatic CAUTI in ICU patients and to test their susceptibility pattern for various antifungal agents. Materials and methods: Study was performed at a 1050 bed tertiary care hospital of northern India. Over a period of 1 year, total 147 urine samples from symptomatic CAUTI patients admitted in ICU were collected. Gram’s staining and culture on CLED agar was done. All yeast isolates were tested for speciation of Candida & antifungal susceptibility by an automated commercial system - VITEK 2. Results: Among 147 urine samples, 34 (23.12%) were positive for various Candida species. 61.76% positive patients were female and 38.23% were male. Maximum numbers of Candida isolates were found in above 60 years age group. 27 (79.41%) were due to non-albicans Candida spp. and 7 (20.58%) were due to Candida albicans. All Candida species were found to be sensitive to voriconazole, amphotericin B, caspofungin and micafungin. Few isolates of certain species like C.albicans and C.non-albicans showed resistance to fluconazole and/or flucytosine. Conclusion: Changing pattern of Candida species causing UTIs around the world points towards continuous need for surveillance, thus helping us in providing appropriate therapy.

BACTERIOLOGICAL PROFILE & ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF THE ISOLATES FROM CASES OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS IN ADULT PATIENTS OF INTENSIVE CARE UNIT FROM A TERTIARY CARE HOSPITAL, VADODARA, GUJARAT.

Introduction: Catheter associated urinary tract infection (CAUTI) is an important healthcare associated infection. More than 80% of nosocomial UTIs are catheter- associated. Patients in intensive care unit have more risk of acquiring CAUTI. Objectives: To determine the incidence rate of CAUTI in ICU set-up, to isolate the organisms, to determine the antimicrobial sensitivity pattern and the association of symptomatic CAUTI in relation to high risk factors. Materials & Methods: A total of 150 symptomatic catheterized patients admitted in medical and surgical ICU were included. The urine samples were subjected for bacteriological analysis. Results: Total 59 patients developed Symptomatic CAUTI, incidence being39.3%. Escherichia coli was the most common isolate (37.9%) followed by Klebsiella species (16.7%), Enterococcus species (15.2%), Pseudomonas aeroginosa (10.6%), Candida spp. (13.6%),Acinetobacter species (4.5%) and Staphylococcus aureus(1.5%).. The bacterial isolates were more sensitive to piperacillin-tazobactam and Nitrofurantoin. Conclusion: To prevent CAUTI, emphasis should be placed on good catheter management and reducing the duration of catheterization to reduce its incidence. Knowledge of resistant pattern can help in implementing proper antibiotic therapy and infection control policy

Randomised controlled trial comparing the clinical and cost-effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters: study protocol for the CATHETER II study

BackgroundVarious washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC.MethodsCATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life.DiscussionThis study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015).Trial registrationISRCTN ISRCTN17116445. Registered prospectively on 06 November 2019

Semi-Quantitative Assay to Measure Urease Activity by Urinary Catheter-Associated Uropathogens.

Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections in the US, accounting for over 1 million cases annually and totaling 450 million USD. CAUTIs have high morbidity and mortality rates and can be caused by a wide range of pathogens, making empiric treatment difficult. Furthermore, when urease-producing uropathogens cause symptomatic CAUTI or asymptomatic catheter colonization, the risk of catheter failure due to blockage increases. The enzyme urease promotes catheter blockage by hydrolyzing urea in urine into ammonia and carbon dioxide, which results in the formation of crystals that coat the catheter surface. If CAUTI is left untreated, the crystals can grow until they block the urinary catheter. Catheter blockage and subsequent failure reduces the quality of life for the chronically catheterized, as it requires frequent catheter exchanges and can promote more severe disease, including dissemination of the infection to the kidneys or bloodstream. Thus, understanding how urease contributes to catheter blockages and/or more severe disease among the broad range of urease-producing microbes may provide insights into better prevention or treatment strategies. However, clinical assays that detect urease production among clinical isolates are qualitative and prioritize the detection of urease from Proteus mirabilis, the most well-studied uropathogenic urease producer. While urease from other known urease producers, such as Morganella morganii, can also be detected with these methods, other uropathogens, including Staphylococcus aureus and Klebsiella pneumonia, are harder to detect. In this study, we developed a high throughput, semiquantitative assay capable of testing multiple uropathogens in a rapid and efficient way. We validated the assay using Jack Bean urease, the urease producing species: Proteus spp., M. morganii, K. pneumonia, and S. aureus strains, and the non-urease producer: Escherichia coli. This modified assay more rapidly detected urease-producing strains compared to the current clinical test, Christensen Urea Agar, and provided semiquantitative values that may be used to further investigate different aspects of urease regulation, production, or activity in these diverse species. Furthermore, this assay can be easily adapted to account for different environmental stimuli affecting urease production, including bacterial concentration, aeration, or addition of anti-urease compounds.

Catheter-Associated Urinary Tract Infections in the Adult Patient Group: A Qualitative Systematic Review on the Adopted Preventative and Interventional Protocols From the Literature.

Catheter-associated urinary tract infections (CA-UTIs) are among the most common nosocomial infections acquired by patients in health care settings. A significant risk factor for CA-UTIs is the duration of catheterization. To summarize the current strategies and interventions in reducing urinary tract infections associated with urinary catheters, use and the need for re-catheterization on the rate of CA-UTIs, we performed a systematic review. A rapid evidence analysis was carried out in the Medline (via Ovid) and the Cochrane Library for the periods of January 2005 till April 2021. The main inclusion criterion required to be included in this review was symptomatic CA-UTI in adults as a primary or secondary outcome in all the included studies. Only randomized trials and systematic reviews were included, reviewed, evaluated, and abstracted data from the 1145 articles that met the inclusion criteria. A total of 1145 articles were identified, of which 59 studies that met the inclusion criteria were selected. Studies of relevance to CA-UTIs were based on: duration of catheterization, indication for catheterization, catheter types, UTI prophylaxis, educational proposals and approaches, and mixed policies and interventions. The duration of catheterization is the contributing risk factor for CA-UTI incidence; longer-term catheterization should only be undertaken where needed indications. The indications for catheterization should be based on individual base to base cases. The evidence for systemic prophylaxis instead of when clinically indicated is still equivocal. However, antibiotic-impregnated catheters reduce the risk of symptomatic CA-UTIs and bacteriuria and are more cost-effective than other impregnated catheter types. Antibiotic resistance, potential side effects and increased healthcare costs are potential disadvantages of implementing antibiotic prophylaxis.Multiple interventions and measures such as reducing the number of catheters in place, removing catheters at their earliest, clinically appropriate time, reducing the number of unnecessary catheters inserted, decrease antibiotic administration unless clinically needed, raising more awareness and provide training of nursing personnel on the latest guidelines, can effectively lower the incidence of CA-UTIs.

Strategies for the removal of short-term indwelling urethral catheters in adults.

Strategies for the removal of short-term indwelling urethral catheters in adults.

Role of noble metal-coated catheters for short-term urinary catheterization of adults: a meta-analysis.

ObjectiveTo evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization.MethodsAn electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included.ResultsA total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44–0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41–0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26–0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high.ConclusionsOur review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.

The Epidemiology of Symptomatic Catheter-associated Urinary Tract Infections in the Intensive Care Unit: A 4-year Single Center Retrospective Study.

Catheter-associated urinary tract infection (CAUTI) occurs frequently in critical illness with signifi-cant morbidity, mortality, and additional hospital costs. The epidemiology of symptomatic ward-acquired CAUTI (within 48 hours of intensive care unit [ICU] admission) has not been carefully examined. The objective of our study was to identify the patient characteristics and microbiology of symptomatic CAUTI in critical illness. A 4-year retrospective observational study (2013-2016) was conducted at a single adult ICU with 30 beds in a tertiary hospital in Northeast China. The enrolled patients were over 18 years of age and had been diagnosed as having symptomatic CAUTIs in the ICU from January 2013 to December 2016. The infor-mation of clinicopathological characteristics (such as age, sex, underlying diseases, hospital admission diagnosis, ICU admission source, severity of illness, duration of urinary catheterization, use of antibiotics, duration of ICU stay, and ICU mortality) was recorded in an electronic database by senior clinicians who were blinded to the study purpose and design. Microbiological data were retrieved from the computerized hospital database. Between January 2013 and December 2016, 4115 patients were admitted to the ICU. Ninety-eight symp-tomatic CAUTI cases were enrolled in this study, including 29 patients who had ward-acquired CAUTI and 69 pa-tients who had ICU-acquired CAUTI. Patients with ward-acquired symptomatic CAUTI had significantly shorter overall ICU length of stay and shorter urinary catheterization time, and the overall ICU mortality was significantly higher in patients who had ICU-acquired symptomatic CAUTI. More third-generation cephalosporins and carbap-enems were used prior to CAUTI in the patients with ICU-acquired symptomatic CAUTI. Escherichia coli and Acinetobacter baumannii were the most common bacteria causing ward-acquired and ICU-acquired CAUTI, re-spectively. There were a higher number of cases of non-Candida albicans infections in patients with ICU-acquired symptomatic CAUTI than in patients with ward-acquired symptomatic CAUTI. Clinical characteristics, microbiological characteristics, and prognosis were different between ward-acquired and ICU-acquired symptomatic CAUTI. Patients with ICU-acquired symptomatic CAUTI had higher overall ICU mortality.

Long-term use of noble metal alloy coated urinary catheters reduces recurrent CAUTI and decreases proinflammatory markers.

Background:The objective of this study was to investigate a case of a permanently (suprapubic) catheterized woman with neurogenic bladder dysfunction. The patient had suffered from recurrent catheter-associated urinary tract infections (CAUTIs) since 2009, despite several prevention approaches and attempts. In 2013, the patient’s catheter was substituted for the BIP Foley Catheter, coated with a noble metal alloy (NMA) of gold, silver, and palladium.Method:This is a retrospective–prospective clinical case study covering 4 years history for the control catheters and up to 2.5 years for the anti-infective BIP Foley Catheter. CAUTI incidences, symptoms, antibiotics, catheter performance, and comfort were evaluated. Levels of proinflammatory cytokines were measured pre- and post-substitution to BIP Foley Catheter in urine of the case and of four other permanently catheterized patients. In addition, the levels of noble metals were assessed in urine of the case subject during use of the BIP Foley Catheter.Results:While using control catheters, the patient experienced symptomatic CAUTIs requiring antibiotics almost every month for 4 years. After 1 month with the BIP Foley Catheter, the symptoms disappeared, and the patient remained free of symptomatic CAUTIs and antibiotic treatment for the following 2.5 years, despite bacteriuria. The patient was satisfied with the comfort during insertion, use, and removal of the BIP Foley Catheter. Urinary levels of the proinflammatory cytokines interleukin (IL)-6, IL-8, and tumor necrosis factor alpha (TNFα) decreased towards normal levels post catheter type substitution. Traces of noble metals detected in a few urine samples were ⩽4% of the permitted daily exposure. The levels of the noble metals gold, silver, and palladium remaining on the BIP Foley Catheter after use were the same as for unused catheters.Conclusion:Long-term use of a NMA-coated catheter was associated with cessation of frequent CAUTIs. The catheter was experienced as comfortable and inflammatory markers were reduced with time. The coating was stable, with no significant metal release into urine and is therefore safe for patient use.

Does cranberry have a role in catheter-associated urinary tract infections?

Catheter-associated urinary tract infections (CA-UTIs) are a prevalent and costly condition, with very few therapeutic options. We sought to evaluate the efficacy of an oral cranberry supplement on CA-UTIs over a six-month period. Subjects with long-term indwelling catheters and recurrent symptomatic CA-UTIs were enrolled to take a once-daily oral cranberry supplement with 36 mg of the active ingredient proanthocyanidin (PACs). Primary outcome was reducing the number of symptomatic CA-UTIs. This was defined by ≥103 (cfu)/mL of ≥1 bacterial species in a single catheter urine specimen and signs and symptoms compatible with CA-UTI. Secondary outcomes included bacterial counts and resistance patterns to antibiotics. Thirty-four patients were enrolled in the trial; 22 patients (mean age 77.22 years, 77.27% were men) completed the study. Cranberry was effective in reducing the number of symptomatic CA-UTIs in all patients (n=22). Resistance to antibiotics was reduced by 28%. Furthermore, colony counts were reduced by 58.65%. No subjects had adverse events while taking cranberry. The cranberry supplement reduced the number of symptomatic CA-UTIs, antibiotic resistances, and major causative organisms in this cohort. Larger, placebo-controlled studies are needed to further define the role of cranberry in CA-UTIs.

Enquête de prévalence sur le sondage vésical dans un centre hospitalo-universitaire

Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution. We conducted a single-centre descriptive cross-sectional study during 1week in September2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI). Amongst 1046patients audited, 125 (12%) had UC. The mean age was 72years (64.8-79.2). UC prevalence was higher in surgical (88%) and medical (87%) intensive care, urology (50%), geriatrics (18%) and long-term care (18%) departments. The average catheterisation length was 7.8days (3.8-11.8); it was shorter in surgery than in medicine departments (3.6 vs 9.7days, P<0.001). Catheters were present for more than 4days in 60% of the cases. Acute urinary retention was the most frequent indication (59%), significantly more in medical than surgical departments (75% vs 26%). Others indications were perioperative (17%), diuresis monitoring (12%), strict immobilization (4%) and unnecessary indications or staff comfort (4%). A SCAUTI was present in 10% of cases, mostly in medicine department (30% vs 8%). The prevalence of our institution is higher than the national prevalence (8.1%), but still below the European average (17.2%). Control of the risk of CAUTI requires compliance with UC appropriate indications, UC management, and prompt removal of unnecessary UC. 4.

PD12-12 EVALUATION OF SURFACE MICROPATTERN (SHARKLET) ON FOLEYS SILICON CATHETER IN REDUCING URINARY TRACT INFECTIONS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2017PD12-12 EVALUATION OF SURFACE MICROPATTERN (SHARKLET) ON FOLEYS SILICON CATHETER IN REDUCING URINARY TRACT INFECTIONS Vinodh Kumar Adithyaa Arthanareeswaran, Andras Magyar, Lila Soos, Bela Koves, Abinaya Ravichandran Chandra, Nora Justh, Imre Miklos Szilagyi, and Tenke Peter Vinodh Kumar Adithyaa ArthanareeswaranVinodh Kumar Adithyaa Arthanareeswaran More articles by this author , Andras MagyarAndras Magyar More articles by this author , Lila SoosLila Soos More articles by this author , Bela KovesBela Koves More articles by this author , Abinaya Ravichandran ChandraAbinaya Ravichandran Chandra More articles by this author , Nora JusthNora Justh More articles by this author , Imre Miklos SzilagyiImre Miklos Szilagyi More articles by this author , and Tenke PeterTenke Peter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.687AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Catheter-associated urinary tract infection (CAUTI) is a major preventable cause of harm in hospitalized patients. Previous in vitro studies have shon wthat a unique surface micropattern on catheter surface reduces bacterial biofilm formation. This single center, open labelled, randomized interventional study evaluated if the Sharklet micropatterned catheter (SC) reduces UTI in catheterized patients, when compared to a standard silicone Foley catheter. (NCT02835456) METHODS Fifty eligible adult men requiring temporary urethral catheterization for a period between 3 and 30 days were randomized into two groups with standard silicone Foley catheter insertion in one and SC in other. On removal, parts of the catheters (tip, middle part and base) were examined for bacterial colonization/biofilm using scanning electron microscopy. The patients were also assessed for incidence of symptomatic UTI, significant asymptomatic bacteriuria, pain and discomfort. RESULTS The mean age and duration of catheterization were similar among both groups. None of the patients developed symptomatic CAUTI. The outer surface of the SC had significantly lower biofilm formation when compared to the standard silicone catheter in all parts of the catheter (Tip: P= 0.003, Middle part: P=0.013 and Base: P=0.013). However, this difference was not noted in the inner surface of the catheters (P= 0.511, P=0.245, P=0.810 respectively); which may be attributed to the absence of micropattern in the inner surface of SC. There was significantly lower pain and discomfort in patients using SC when compared to the standard catheter (p=0.018). CONCLUSIONS Catheters that can reduce CAUTI have the advantage of improving the care of millions of disabled and elderly patients and reducing the enormous costs of managing complications associated with indwelling Foley catheter. However, none of the numerous strategies tested until now, like antibiotic or silver impregnation on catheter surface have proved to be useful in this regard. This is the first trial to test the efficacy of Sharklet micropattern on urinary catheter surface in a clinical setting. The promising results of this study opens the arena for novel mechanical modifications on catheter surface which may be both cost effective and clinically beneficial. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e270 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Vinodh Kumar Adithyaa Arthanareeswaran More articles by this author Andras Magyar More articles by this author Lila Soos More articles by this author Bela Koves More articles by this author Abinaya Ravichandran Chandra More articles by this author Nora Justh More articles by this author Imre Miklos Szilagyi More articles by this author Tenke Peter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Policies for replacing long-term indwelling urinary catheters in adults.

Long-term indwelling catheters are used commonly in people with lower urinary tract problems in home, hospital and specialised health-care settings. There are many potential complications and adverse effects associated with long-term catheter use. The effect of health-care policies related to the replacement of long-term urinary catheters on patient outcomes is unclear. To determine the effectiveness of different policies for replacing long-term indwelling urinary catheters in adults. We searched the Cochrane Incontinence Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 19 May 2016), and the reference lists of relevant articles. All randomised controlled trials investigating policies for replacing long-term indwelling urinary catheters in adults were included. At least two review authors independently performed data extraction and assessed risk of bias of all the included trials. Quality of evidence was assessed by adopting the GRADE approach. Any discrepancies were resolved by discussion between the review authors or an independent arbitrator. We contacted the authors of included trials to seek clarification where required. Three trials met the inclusion criteria, with a total of 107 participants in three different health-care settings: A USA veterans administration nursing home; a geriatric centre in Israel; and a community nursing service in Hong Kong. Data were available for three of the pre-stated comparisons. Priefer and colleagues evaluated different time intervals between catheter replacement (n = 17); Firestein and colleagues evaluated the use of antibiotic prophylaxis at the time of replacement (n = 70); and Cheung and colleagues compared two different types of cleaning solutions (n = 20).All the included trials were small and under-powered. The reporting of the trials was inadequate and as a result, risk of bias assessment was judged to be unclear for the majority of the domains in two out of the three trials. There was insufficient evidence to indicate that (i) there was a lower incidence of symptomatic UTI in people whose catheter was changed both monthly and when clinically indicated (risk ratio (RR) 0.35, 95% confidence interval (CI) 0.13 to 0.95; very low quality evidence) compared to only when clinically indicated, (ii) there was not enough evidence to assess the effect of antibiotic prophylaxis on reducing: positive urine cultures at 7 days (RR 0.91, 95% CI 0.79 to 1.04); infection (RR 1.41, 95% CI 0.55 to 3.65); or death (RR 2.12, 95% CI 0.20 to 22.30; very low quality evidence), (iii) there was no statistically significant difference in the incidence of asymptomatic bacteruria at 7 days (RR 0.80, 95% CI 0.42 to 1.52) between people receiving water or chlorhexidine solution for periurethral cleansing at the time of catheter replacement. However, none of the 16 participants developed a symptomatic catheter-associated urinary tract infection (CAUTI) at day 14.The following outcomes were considered critical for decision-making and were also selected for the 'Summary of findings' table: (i) participant satisfaction, (ii) condition-specific quality of life, (iii) urinary tract trauma, and (iv) formal economic analysis. However, none of the trials reported these outcomes.None of the trials compared the following comparisons: (i) replacing catheter versus other policy e.g. washouts, (ii) replacing in the home environment versus clinical environment, (iii) clean versus aseptic technique for replacing catheter, (iv) lubricant A versus lubricant B or no lubricant, and (v) catheter user versus carer versus health professional performing the catheter replacement procedure. There is currently insufficient evidence to assess the value of different policies for replacing long-term urinary catheters on patient outcomes. In particular, there are a number of policies for which there are currently no trial data; and a number of important outcomes which have not been assessed, including patient satisfaction, quality of life, urinary tract trauma, and economic outcomes. There is an immediate need for rigorous, adequately powered randomised controlled trials which assess important clinical outcomes and abide by the principles and recommendations of the CONSORT statement.

Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults.

Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults.

Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections.

PURPOSE:The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs).DESIGN:Multicenter before-after non-randomized cohort study.SUBJECTS AND SETTING:Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study. The study population included adult patients with a positive urine culture 2 or more days after admission, who underwent Foley catheterization.METHODS:Catheter-associated urinary tract infection surveillance was conducted at each hospital for at least 3 months during the use of a standard catheter and 3 months during the use of the silver-alloy hydrogel catheter. Both the National Healthcare Safety Network (NHSN) surveillance and a clinical definition of CAUTI were used for rate calculation.RESULTS:A 47% relative reduction in the CAUTI rate was observed with the silver-alloy hydrogel catheter compared to the standard catheter when both infection definitions were used (0.945/1000 patient days vs 0.498/1000 patient days) (odds ratio = 0.53; P < .0001; 95% CI: 0.45–0.62). When only NHSN-defined CAUTIs were considered, a 58% relative reduction occurred in the silver-alloy hydrogel period (0.60/1000 patient days vs 0.25/1000 patient days) (odds ratio = 0.42; P < .0001; 95% CI: 0.34–0.53). Antimicrobial days for CAUTIs decreased from 1165 (standard catheter period) to 406 (silver-alloy hydrogel period).CONCLUSIONS:Use of a silver-alloy hydrogel urinary catheter reduced symptomatic CAUTI occurrences as defined by both NHSN and clinical criteria.

Diagnostic accuracy of urinary dipstick to exclude catheter-associated urinary tract infection in ICU patients: a reappraisal

We wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia. This was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR-). Symptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53-40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76-42.39). LR- was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57-0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21-0.60). Urinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.

A multifaceted intervention to reduce rates of catheter-associated urinary tract infections in a resource-limited setting

Health care-associated infections such as catheter-associated urinary tract infections (CAUTIs) are prevalent in resource-limited settings. This study was carried out to determine whether a multifaceted intervention targeting health care personnel would reduce CAUTI rates in a public hospital located in a resource-limited setting. A one group, pretest-posttest study was carried out from March to July 2012 in a public district hospital in Nairobi, Kenya. Patients admitted to adult medical wards, and who received urinary catheters, were evaluated for symptomatic CAUTIs using a modified definition by the Centers for Disease Control and Prevention. After collecting baseline CAUTI rates for 8 weeks, a multifaceted intervention consisting of lectures, reminder signs, and infection prevention rounds (week 9) was implemented. The postintervention rate of CAUTIs was measured over 7 subsequent weeks. Bivariable analysis was performed to determine whether the intervention was associated with reduced CAUTIs. A total of 125 patients received urinary catheters, with 82 preintervention and 43 postintervention. Mean duration of catheterization did not change between phases (6.9 vs 5.6 days, respectively, P= .322), but catheter utilization ratio decreased from 0.14 to 0.09 (P < .001). There were 13 preintervention CAUTIs (for 30.4 infections per 1,000 catheter-days) and no postintervention CAUTIs (P=.002). In this resource-limited setting, the baseline rate of CAUTIs was high. A low-cost, multifaceted intervention resulted in decreased urinary catheter use and CAUTI rates.

Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study

Plants extracts are used in urology to manage urinary tract infections. We aimed to evaluate the efficacy of a preparation with solidago, orthosiphon, birch and cranberry extracts (CISTIMEV PLUS(®)) in reducing microbial colonization and biofilm development in patients with indwelling urinary catheters. All consecutive outpatients attending our department between January and June 2010 for the substitution of indwelling catheters were considered for this single-blinded, randomized and controlled pilot study to test superiority of the preventative management (CISTIMEV PLUS(®), 1 tablet daily for 30 days) in respect to no treatment. A sample size of 10-40 participants per group was considered adequate. All patients underwent urine culture the same day of the catheter substitution and were then randomized into test group (n = 48) and control group (n = 35). Ultrastructural analysis was also performed. After 30 days, the catheter was replaced and the analysis repeated. The primary outcome was the rate of positive urinary culture at the end of the entire study period. Ten patients abandoned the study. At 30 days, according to per-protocol analysis, the groups statistically differed regarding the rate of positive urine cultures: test group 10/43 and control group 16/30 (p = 0.013) (-30.1 % [95 % CI -51.94 to -8.21]). The most common isolated bacteria were Escherichia coli and Enterococcus faecalis. The use of solidago, orthosiphon, birch and cranberry extracts resulted in a significant reduction of microbial colonization in patients with indwelling urinary catheters. Larger clinical trials are needed to demonstrate that the effects here reported are sufficient to reduce symptomatic catheter-associated urinary tract infections.