An Evaluation of Daily Bacteriologic Monitoring to Identify Preventable Episodes of Catheter-Associated Urinary Tract Infection

Abstract

We evaluated the efficacy of a daily bacteriologic monitoring program for preventing symptomatic urinary tract infections (UTI) in hospitalized patients with temporary indwelling urethral catheters. We identified 99 instances in which bacteriuria was present at the time of catheter insertion among 1,140 catheterizations. Of those, 62 patients were asymptomatic and 37 patients had fever or symptoms attributable to UTI. Of the 37 symptomatic episodes, only 14 developed symptoms 24 hours or more after the first culture and might be considered potentially preventable.We also identified 76 episodes of acquired bacteriuria among 608 catheterizations that were initially non-bacteriuric in which at least two cultures were available. Of these 76 patients, 51 (67%) remained asymptomatic throughout their period of hospitalization. Of the 25 patients who developed symptomatic infections, only ten were potentially preventable.In all, only 24 symptomatic episodes among 1,140 catheterizations (2%) occurred 24 hours or more after colonization was first detected and might be considered potentially preventable. Our data suggest that routine daily bacteriologic monitoring of urine from all catheterized patients is not an efficient way to decrease the incidence of symptomatic, catheter-associated UTI.

Urinary tract colonization and infection in critically ill patients

“…Among the risk factors that have been related to colonization of the urinary tract in the ICU, special mention must be made of bladder catheters. 3,19 In the NNIS report and in a study published by Van Der Kooi et al in Holland, a full 95% of all urinary tract infections were associated to bladder catheters, 1,4 thus evidencing the importance of these devices in relation to urinary infection. There is an average 2---6% colonization rate for every day with the bladder catheter in place.…”

Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

“…These findings are consistent with previous studies. 3,[27][28][29][30][31] In resource-limited settings, cost is an important issue to consider before the implementation of any intervention. Data derived from the University of Michigan Health System 3 suggest that the minimum cost of evaluating and treating a patient with CA-UTI-related bacteremia is $2,836 (including the costs of additional laboratory tests and treatment).…”

Bacteriophage-Mediated Control of a Two-Species Biofilm Formed by Microorganisms Causing Catheter-Associated Urinary Tract Infections in anIn VitroUrinary Catheter Model

“…Microorganisms may colonize indwelling urinary catheters and form extensive and often multispecies biofilm (4)(5)(6)(7)(8). The exact role of catheter-associated biofilms in CAUTI pathogenesis is poorly understood, but there is evidence that such biofilms play an important role as stable reservoirs of uropathogenic microorganisms that are resistant to antimicrobials (9)(10)(11)(12) and difficult to eliminate even if the catheter is removed (13)(14)(15).…”