CAUTI – UTI occurring in a person whose urinary tract is current catheterised, or has had a catheter in place within the past 48 hours
Leading cause of hospital acquired bacteraemia – about 20 % of hospital acquired bacteraemia arises from urinary tract.
Reported incidence of bacteriuria 3 – 10 % per day of catheterisation.
1 – 3 % per catheterisation in ISC patients.
Systematic review/meta-analysis:
- Prevalence of 9 – 10 % hospitalised patients
- Those at high risk
- Female
- Prolonged duration of catheter
- Diabetic
- Longer LOS / ICU stay
CAUTI are often polymicrobial and associated with drug resistant organisms.
CAUTI mechanisms:
- Permits easy access of organisms from outside to bladder
- Organisms may be introduced during initial catheterisation procedure
- Provide surface for attachment of adhesins
- Damage to epithelium exposes new binding sites for adhesins
- Residual urine pools below catheter balloon
Difficult to differentiate catheter associated UTI vs catheter associated asymptomatic bacteriuria.
Symptoms of CA-UTI include:
- Usual UTI symptoms if catheter removed < 48 hours ago
- Fever and rigors
- Mental status change
- Flank pain / renal tenderness
- Acute haematuria
- Pelvic discomfort
There is no benefit to treating asymptomatic bacteriuria in catheterised patients (unless undergoing procedure).
There is no role for routine urine culture in asymptomatic catheterised patients.
Management and prevention of CAUTI:
- Limiting catheter duration
- Maintain closed circuit
- Minimal evidence for urethral cleansing or chlorhexidine bathing
- Hydrophilic coated catheters have lower UTI rates cf. PVC catheters
Suprapubic vs IDC:
- Insufficient evidence to suggest a difference in UTI or bacteriuria rates (Cochrane review inconclusive)
Treatment:
- Replace or remove the catheter prior to starting antibiotics
- Get a urine sample for culture prior to commencing antibiotics – ideally mid stream or from a new catheter
- Treat as you would for a complicated UTI, based on previous sensitivities if available