Catheter-acquired urinary tract infections

Indwelling bladder catheters are widely used in intensive care units to monitor the hourly urine output in critically ill patients. In-hospital patients are frequently catheterized (15–25%), but catheterization is often unappropriated. A 30-day cutoff is used to differentiate between short- and long-term (or chronic) catheterization. Recent data confirmed that CAUTIs represent 23% of HAIs in ICU. In ICU patients, female gender (HR 2.67, 95% CI 1.03–6.91; p 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01–1.13; p 0.019) were identified as risk factors for CAUTI acquisition alone. Bundles’ implementation relates with a significant reduction in CAUTI incidence. The urinary catheter bundle includes five interventions: perform hand hygiene before insertion and manipulation of UC; keep collection bag lower than the bladder level; maintain unobstructed urine flow; empty collecting bag regularly and avoid allowing the draining spigot to touch the collection catheter; and monitor CAUTIs using standardized criteria to identify patients with CAUTIs and to collect UC days as denominators. No other routine interventions (such as catheter or collection bag changing, bladder irrigation, systemic and bladder antimicrobial administration) are recommended to prevent CAUTIs. Although CAUTIs have a strong impact on hospitalized patients’ outcomes, studies concerning the prevention of this problem are generally affected by poor-quality evidences and methodological issues. Therefore several research questions remain unresolved.