Catheter Associated Urinary Tract Infection (CAUTI)

by Dr. Evalyn A. Roxas

1. Evalyn A. Roxas, MD, FPCP, FPSMID!
Basic Competency Training Course For Infection Control Nurses!
AGT Auditorium PNA Building !
February 17, 2016
Catheter-associated UTI

2. Diagnosis, Prevention, and Treatment of
Catheter-Associated Urinary Tract Infection in
Adults:









2009 International Clinical Practice Guidelines from
the Infectious Diseases Society of America






3. 3

4. Catheter-Associated (CA) Infection
- a person who is currently catheterized
- has been catheterized within the
previous 48 hours
!
Urinary Tract Infection (UTI)
- significant bacteriuria
- symptoms and signs attributable to UTI
- no alternate source

5. Definition
Asymptomatic Bacteriuria (ASB)
- significant bacteriuria
- without signs and symptoms attributable
to UTI
!
Bacteriuria
- non specific term that can refer to ASB or
UTI

6. Epidemiology
CA-bacteriuria is the most common health-
care associated infection worldwide.
Tambyah PA. Catheter Associated urinary tract infections: diagnosis and prophylazixs.
Int J Antimicrob Agents 2004; 24(Suppl 1):S44-S48
The incidence of bacteriuria associated with
indwelling catheters is 3% - 8% per day.
Garibaldi RA, Burke JP, Dickman ML, et al. Factors predisposing tobacteriuria during indwelling urethral catheterization.
N Engl J Med1974; 291:215–219.
The duration of catheterization is the most
important risk factor for the development
of CA-bacteriuria.
Saint S, Lipsky BA. Preventing catheter-related bacteriuria: shouldwe? Can we? How?
Arch Intern Med 1999; 159:800–808.

7. Microbiology
▪ Bacteriuria in patients with short-term
catheters is usually caused by a single
organism.
Tambyah PA, Maki DG. Catheter-associated urinary tract infection israrely symptomatic:
a prospective study of 1,497 catheterized patients. Arch Intern Med 2000; 160:678–682.
!
▪ E. coli is the most frequent species
isolated.
Nicolle LE. Catheter-related urinary tract infection. Drugs Aging 2005; 22:627–639.
!
▪ Other Enterobacteriaceae (Klebsiella,
Serratia, Citrobacter, Enterobacter),
Pseudomonas, Gram positive cocci,
CONS, Enteroccocus
Nicolle LE. Catheter-related urinary tract infection. Drugs Aging 2005; 22:627–639.

8. Microbiology
▪ UTIs in patients with long-term
catheterization is usually
polymicrobial…species such as P.
mirabilis, Morganella morganii, P.
stuartii are common.
Nicolle LE. Catheter-related urinary tract infection. Drugs Aging 2005; 22:627–639.
!
▪ New episodes of infection often
occur periodically in the presence
of existing infection.
Warren JW, Tenney JH, Hoopes JM, et al. A prospective microbiologicstudy of bacteriuria
in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146:719–723.

9. 9
Table 1. Risk factors for catheter-associated urinary tract infection,
based on prospective studies and use of multivariable statistical modellingFactor Relative Risk
Prolonged Catheterization >6 days 5.1 - 6.8
Female Gender 2.5 - 3.7
Catheter insertion done outside the operating room2.9 - 5.3
Urology Service 2.0 - 4.0
Other active site of infection 2.2 - 2.4
Diabetes 2.3 – 2.4
Malnutrition 2.4
Azotemia (creatinine > 2.0mg/dl) 2.1 – 2.6
Ureteral Stent 2.5
Monitoring of Urine Output 2.0
Drainage tube below bladder but above collection
bag
1.9
Antibiotic usage 0.1 – 0.4
Adapted from Maki, D.G. and P.A. Tambyah, Engineering out the risk for infection with urinary catheters.
Emerg Infect Dis, 2001 Mar-Apr. 7(2): p. 342-347.

10. Complications of Short-Term Catheterization
Less than 25% of hospitalized patients with CA-
bacteriuria develop UTI symptoms.
Hartstein AI, Garber SB, Ward TT, et al. Nosocomial urinary tractinfection: a prospective evaluation of 108 catheterized patients.
Infect Control 1981; 2:380–386.
!
Approximately 15% of cases of nosocomial
bacteremia are attributable to the GUT.
Bryan CS, Reynolds KL. Hospital-acquired bacteremic urinary tractinfection: epidemiology and outcome.
J Urol 1984; 132:494–498.
!
Bacteriuria is the most common source of gram-
negative bacteremia among hospitalized
patients.
Kreger BE, Craven DE, Carling PC, et al. Gram-negative bacteremia.III. Reassessment of etiology, epidemiology and ecology in 612 patients.
Am J Med 1980; 68:332–343.

11. Complications of Short-Term Catheterization
The effect of CA-bacteriuria on mortality
remains controversial.
Platt R, Polk BF, Murdock B, et al. Mortality associated with nosocomialurinary-tract infection.
N Engl J Med 1982; 307:637–642.
!
Patients who develop CA-bacteriuria have
their hospital stays extended by 2-4 days.
Givens CD, Wenzel RP. Catheter-associated urinary tract infections in surgical patients:
a controlled study on the excess morbidity andcosts. J Urol 1980; 124:646–648.
Green MS, Rubinstein E, Amit P. Estimating the effects of nosocomial infections
on the length of hospitalization.J Infect Dis 1982; 145: 667–672.
CA-ASB comprises a large reservoir of
antimicrobial-resistant organisms.
Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters.
Emerg Infect Dis 2001; 7:342–347.

12. Complications of Long-Term Catheterization
(>30 days)
▪Universal bacteriuria
▪Lower and upper CA-UTI
▪Bacteremia
▪Frequent febrile epdisodes
▪Renal and bladder stone formation
▪Catheter obstruction
▪Local GU infections
▪Fistula formation incontinence
▪Bladder cancer
!
Warren JW. Catheter-associated urinary tract infections.!
Infect Dis Clin North Am 1997; 11:609–622.

13. 13

14. 14
When is catheter-associated UTI (CA-UTI) suspected or diagnosed?
1.1 UTI in patients with indwelling urethral or suprapubic catheter or
in those undergoing intermittent catheterization is termed as CA-UTI.
CA-UTI is diagnosed when:
(1) signs or symptoms compatible with UTI are present with no other
identified source of infection
(2) ≥ 10
3
colony forming units (CFU)/ml of ≥ 1 bacterial species are
present in a single catheter urine specimen or in a midstream
voided urine specimen
(3) in a patient with an indwelling urethral, suprapubic or condom
catheter or has been removed within the previous 48 hours.

Strong recommendation, Low quality of evidence
!
1.2 There is no sufficient evidence to define the quantitative cut-off for
CA-UTI among men with condom catheters.

Weak recommendation, Low quality of evidence

15. Diagnosis
(1) CA-UTI is defined by presence of
symptoms or signs compatible with UTI with
no other identified source along with >=
1000 cfu/mL of >= 1 bacterial species (A-
III).*
!
Lipsky BA, Ireton RC, Fihn SD, et al. Diagnosis of bacteriuria in men: specimen collection and culture interpretation.
J Infect Dis 1987; 155: 847–854.
Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines
for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40:643–654.
!
* Has a 97% sensitivity and 97% specificity

16. 16
Should patients with indwelling urethral, indwelling suprapubic or
intermittent catheterization be screened and treated for asymptomatic
bacteriuria?
!
2.1 Screening and treatment of catheter-associated
asymptomatic bacteriuria (CA-ASB) are NOT routinely
recommended.
Strong recommendation, Moderate quality of evidence

2.2 Screening and treatment of CA-ASB are recommended only
for pregnant patients and those who will undergo urologic
procedures.
Strong recommendation, Moderate quality of evidence
!
2.3 Data is insufficient to make any recommendations regarding
screening and treatment of CA-ASB among post-solid organ
transplant and neutropenic patients.

17. 17
In patients with suspected CA-UTI, what diagnostic tests should be
done to assist the physician in managing the infection effectively?
!
3.1 Similar with the general recommendations in complicated
UTI, it is necessary to obtain urine gram stain and cultures
BEFORE starting empiric antibiotic coverage for CA-UTI.
Strong recommendation, Moderate quality of evidence
3.2 In catheterized patients, pyuria alone is NOT diagnostic
of CA-UTI and should not be interpreted as an absolute
indication for initiating empiric antibiotics.
Strong recommendation, Moderate quality of evidence
!
3.3 The presence or absence of odorous or cloudy urine
alone in catheterized patients is also not an indication for
antibiotic treatment.
Strong recommendation, Low quality of evidence

18. 18
How should urine for culture and sensitivity studies be collected from
patients with suspected CA-UTI?
!
4.1 For patients in whom catheterization is still indicated, the urine specimen
should be obtained from the freshly placed catheter prior to the initiation of
antimicrobial therapy. Urine sample should be aspirated from the catheter
port, or if not present, by puncturing at the distal end of the catheter with
sterile needle and syringe after disinfecting the area WITHOUT disconnecting
the junction of the catheter and drainage tube.
Strong recommendation, Low quality of evidence
!
4.2 For individuals whose catheters can be or have been recently removed
and requires no further catheterization, a mid-stream, clean catch urine
should be obtained. Urine samples for culture should not be obtained
from collection bags.
Strong recommendation, Low quality of evidence
!
4.3 Urine specimens for culture should be processed as soon as
possible, preferably within one hour of obtaining the specimen. If this
is not possible, the urine specimen should be refrigerated.
Refrigerated specimens should be processed within 24 hours.
Strong recommendation, Low quality of evidence

19. 19
Table 4. Antibiotics Options for the Treatment of CA-UTI Antibiotic
Recommended Dose and
Duration
Comments
Amikacin (First line)15 mg/kg q24h Be cautious in giving aminoglycosides in patients with
renal insufficiency
Ertapenem 1g IV q24h For patients with no risk for Pseudomonas or
Enterococcus
Anti-Pseudomonal carbapenems For patients with risk for Pseudomonas infection
For ESBL-producing Enterobacteriaceae
Doripenem
Imipenem-cilastin
Meropenem
500 mg q8h
500 mg q6h
1 g q8h
Vancomycin 1g IV q 12 For suspected staphylococcal infections
Colistin (Colistimethate sodium) For multidrug-resistant Enterobacteriaceae, Klebsiella
pneumonia carbapenemase-producing (KPC) bacteria,
Multi-drug resistant (MDR) Pseudomonas sp. or MDR
Acinetobacter sp.
Colomycin 31,250–62,500 IU/kg per
day, divided in 2-4 equal
doses
(240-480 mg/kg/day)
Coly-Mycin Double the dose of
colomycin (400-800 mg/kg/
day)
Tigecycline 100 mg IV loading dose then
50 mg IV q12
For vancomycin-resistant Enterococci
For ESBL-producing Enterobacteriaceae (except
Pseudomonas sp.

20. 20 Antibiotic Recommended Dose and Duration Comments
Tigecycline100 mg IV loading dose then 50 mg For vancomycin-resistant
Ampicillin 1-2 g IV q6-8h For susceptible enterococcal
Cefepime 1-2 g IV q8-12h For Pseudomonas or Acinetobacter
sp. infections Ceftazidime1-2 g IV q8h+
Piperacillin-4.5 g IV q24
Levofloxacin750 mg q24h For mild infections with no history
Fluconazole For fungal infections (see Section
on Urinary Candidiasis and Candida Amphotericin
Table 4. Antibiotics Options for the Treatment of CA-UTI

21. 21
What is the approach to the presence of the
indwelling urinary catheter once the diagnosis of
CA-UTI is made?
!
Whenever possible, the indwelling catheter should be
removed to help eradicate the bacteriuria.
Strong recommendation, High quality of evidence
!
For patients in whom indwelling bladder
catheterization is necessary, long-term indwelling
catheters should be replaced with new catheters before
initiating antimicrobial therapy for symptomatic UTI.
Strong recommendation, High quality of evidence

22. 22
Table 5. Strategies for reducing the risk of CA-UTIStrategy Strength of
Recommendation
Level of
Evidence
Use indwelling catheters only when necessary Strong Low
Use aseptic technique including appropriate
hand hygiene and sterile gloves
Strong Low to Moderate
Allow only trained health personnel to insert
foley catheters
Weak Low
Properly secure catheters after insertion to
prevent movement and urethral traction
Weak Low
Maintain a closed sterile drainage system. Strong Moderate
Maintain good hygiene at the catheter-
urethral interface.
Strong Moderate
Maintain unobstructed urine flow Strong Moderate
Remove catheters when no longer needed. Strong High
Do not change indwelling catheters or
drainage bags at fixed intervals.
Weak Low

23. Prevention 

(Limiting Unnecessary Catheterization)
(6) Indwelling catheters should be placed
only when they are indicated (A-III).
Saint S, Lipsky BA. Preventing catheter-related bacteriuria: should we? Can we? How? Arch Intern Med 1999; 159:800–808.
!
(6 i) Indwelling urinary catheters should not
be used for the management of urinary
incontinence (A-III). *
Munasinghe RL, Yazdani H, Siddique M, et al. Appropriateness of use of indwelling urinary catheters in patients admitted to
themedical service.
Infect Control Hosp Epidemiol 2001; 22:647–649.
Gardam MA, Amihod B, Orenstein P, et al. Overutilization of indwelling urinary catheters
and the development of nosocomial urinary tract infections. Clin Perform Qual Health Care 1998; 6:99–102.
!
!
* When all approaches to management of incontinence have not
been effective, it may be considered at patients request.

24. Prevention 

(Limiting Unnecessary Catheterization)
▪Clinically significant
urinary retention
!
!
!
▪Temporary relief or
long-term drainage if
medical therapy is NOT
effective and surgical
correction is not
indicated
!
▪For comfort in
terminally ill patient;
if less invasive
measures fail and
external collection
devices are not an
acceptable alternative
Acceptable Indications for Indwelling Catheter
Use

25. Prevention (Limiting Unnecessary Catheterization)
▪Accurate urine output
monitoring required
!
!
▪Patient unwilling or
unable to collect urine
▪Frequent or urgent
monitoring needed,
such as in critically ill
patients
!
▪During prolonged
surgical procedures
with general or spinal
anesthesia; selected
urological and
gynecologic
procedures in the
perioperative period
Acceptable Indications for Indwelling Catheter
Use

26. Prevention 

(Limiting Unnecessary Catheterization)
(7) Institutions should develop a list of
appropriate indications for inserting
indwelling urinary catheters, educate staff
about such indications, and periodically
assess adherence to the institution-specific
guidelines (A-III).
!
Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet
improves appropriate use of foley catheters. Am J Infect Control 2007; 35:589–593.

27. Prevention (Limiting Unnecessary Catheterization)
NOTE:
The Panel did not find evidence that the routine
use of catheters in patients with pressure ulcers
improved wound healing when compared with
other measures to prevent urinary incontinence.
Therefore this was not recommended as an
appropriate indication for routine urinary
catheter placement..
(As opposed to the guidelines released below)
Centers for Disease Control and Prevention. Healthcare Infection
Control Practices Advisory Committee (HICPAC) Web page. http://
www.cdc.gov/hicpac/index.html. Accessed 21 January 2010.

28. Prevention 

(Indwelling Catheter Insertion Technique)
(24) Indwelling urethral catheters should be
inserted using aseptic technique and sterile
equipment (B-III).
!
Tambyah PA, Halvorson KT, Maki DG. A prospective study of pathogenesis of catheter-associated
urinary tract infections. Mayo Clin Proc 1999; 74:131–136.
!
Catheter insertion outside the operating room
is associated with increased risk of early CA-
bacteriuria.
!
Shapiro M, Simchen E, Izraeli S, et al. A multivariate analysis of risk factors for acquiring bacteriuria
in patients with indwelling urinary catheters for longer than 24 hours. Infect Control 1984; 5:525–532.

29. 29
It is recommended that appropriate strategies for the
prevention of CAUTI (listed in Table 5) be included and
implemented in an institution-specific, multimodal, quality
improvement bundle.
!
Periodic assessment of compliance with these bundles, once
instituted, is likewise recommended.
!
Strong recommendation, Moderate quality of evidence

30. 30
Is condom catheter a reasonable alternative to indwelling catheterization
in the prevention of CAUTI?
!
Condom catheterization is an alternative to indwelling
catheter for male patients in whom a urinary catheter
is necessary provided post-void residual urine is
minimal and the patient has no cognitive impairment.
!
Strong recommendation, High quality of evidence

31. 31
Is intermittent catheterization a reasonable alternative to
indwelling catheterization to prevent CAUTI?
!
!
Intermittent catheterization can also be considered an alternative
to short term (Strong recommendation, Moderate quality of
evidence,) or long-term (Weak recommendation, Moderate quality
of evidence) indwelling urinary catheterization with trained and
dedicated healthcare staff.
!
Intermittent catheterization however
requires more manpower hours as well as the full cooperation of
patients for frequent repeated catheterization.

32. 32
Is suprapubic catheterization an alternative to urethral
catheterization?
!
!
Suprapubic catheterization may be an alternative to urethral
catheterization when there are excellent support mechanisms
from the surgical and caregiver staff.

Weak recommendation, Low quality of evidence

33. Prevention 

(Alternatives to Indwelling Urethral Catheterization)
(19) Clean (nonsterile) rather than sterile
technique may be considered in outpatient
(A-III) and institutional (B-I) settings with
no difference in risk of CA-bacteriuria or
CA-UTI.
!
Moore KN, Burt J, Voaklander DC. Intermittent catheterization in the rehabilitation setting:
a comparison of clean and sterile technique. Clin Rehabil 2006; 20:461–468.

34. Prevention 

(Alternatives to Indwelling Urethral Catheterization)
(20) Multiple-use catheters may be
considered instead of sterile single-use
catheters in outpatient (B-III) and
institutional (C-I) settings with no
difference in risk of CA-bacteriuria or CA-
UTI.
!
Moore KN, Kelm M, Sinclair O, et al. Bacteriuria in intermittent catheterization users:
the effect of sterile versus clean reused catheters. Rehabil Nurs 1993; 18:306–309.

35. Prevention 

(Closed Catheter System)
(25) A closed catheter drainage system, should
be used to reduce CA-bacteriuria (A-II) and CA-
UTI (A-III) in patients with short-term
indwelling urethral or suprapubic catheters and
to reduce CA-bacteriuria (A-III) and CA-UTI (A-
III) in patients with long-term indwelling
urethral or suprapubic catheters.
!
Thornton GF, Andriole VT. Bacteriuria during indwelling catheter drainage. II.
Effect of a closed sterile drainage system. JAMA 1970; 214:339–342.
Wolff G, Gradel E, Buchman B. Indwelling catheter and risk of urinary infection:
a clinical investigation with a new closed-drainage system. Urol Res 1976; 4:15–18.

36. Prevention

(Closed Catheter System)
(26) Use of a preconnected system may be
considered to reduce CA-bacteriuria.
Platt R, Polk BF, Murdock B, et al. Reduction of mortality associated with nosocomial urinary tract infection.
Lancet 1983; 1:893–897
.
(27) Use of a complex closed drainage system
or application of tape at the junction after
catheter insertion is NOT recommended to
reduce CA-bacteriuria or CA-UTI.
Huth TS, Burke JP, Larsen RA, et al. Clinical trial of junction seals for the prevention of urinary catheter-associated bacteriuria.
Arch Intern Med 1992; 152:807–812.

37. Prevention 

(Antimicrobial-Coated Catheters)
(28) In patients with short-term indwelling
urethral catheterization, antimicrobial (silver
alloy or antibiotic)-coated urinary catheters
may be considered to reduce or delay the onset
of CA-bacteriuria.
!
Drekonja DM, Kuskowski MA, Wilt TJ, et al. Antimicrobial urinary catheters: a systematic review.
Expert Rev Med Devices 2008; 5:495–506.
Johnson JR, Kuskowski MA,Wilt TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated
urinary tract infection in hospitalized patients. Ann Intern Med 2006; 144:116–126.
Saint S, Elmore JG, Sullivan SD, et al. The efficacy of silver alloycoated urinary catheters
in preventing urinary tract infection: a metaanalysis. Am J Med 1998; 105:236–241.

38. Prevention 

(Prophylaxis with Systemic Antimicrobials)
(29) Systemic antimicrobial prophylaxis should NOT
be routinely used in patients with short-term (A-III)
or long-term (A-II) catheterization, to reduce CA-
bacteriuria or CA-UTI because of concern about
selection of antimicrobial resistance.
!
Niel-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults.
Cochrane Database Syst Rev 2005: CD005428.
Jaffe R, Altaras M, Fejgin M, et al. Prophylactic single-dose co-trimoxazole for prevention of urinary tract infection
after abdominal hysterectomy. Chemotherapy 1985; 31:476–479.
van der Wall E, Verkooyen RP, Mintjes-de Groot J, et al. Prophylactic ciprofloxacin
for catheter-associated urinary-tract infection. Lancet 1992; 339:946–951.

39. Prevention 

(Prophylaxis with Methenamine Salts)
(31) Methenamine salts may be considered for
the reduction of CA-bacteriuria and CA-UTI in
patients after a gynecological surgical
procedure who are catheterized for no more
than 1 week (C-I).
Lee BB, Simpson JM, Craig JC, et al. Methenamine hippurate for preventing urinary tract infections.
Cochrane Database Syst Rev 2007: CD003265.
!
* It is reasonable to assume that a similar effect would be seen after other
types of surgical procedures.

40. Prevention 

(Prophylaxis with Cranberry Products)
(33) Cranberry products should NOT be used
routinely to reduce CA-bacteriuria or CA-UTI
in patients with neurogenic bladders
managed with intermittent or indwelling
catheterization (A-II).
!
Jepson RG, Craig JC. Cranberries for preventing urinary tract infections.
Cochrane Database Syst Rev 2008:CD001321.

41. Prevention 

(Enhanced Meatal Care)
(34) Daily meatal cleansing with povidone-
iodine solution, silver sulfadiazine,
polyantibiotic ointment or cream, or green
soap and water is NOT recommended for
routine use in men or women with indwelling
urethral catheters to reduce CA-bacteriuria
(A-I).
!
Burke JP, Garibaldi RA, Britt MR, et al. Prevention of catheter-associated urinary tract infections:
efficacy of daily meatal care regimens.Am J Med 1981; 70:655–658.
Burke JP, Jacobson JA, Garibaldi RA, et al. Evaluation of daily meatal care with poly-antibiotic ointment
in prevention of urinary catheterassociated bacteriuria. J Urol 1983; 129:331–334.
Marples RR, Kligman AM. Methods for evaluating topical antibacterial agents on human skin.
Antimicrob Agents Chemother 1974; 5:323–329.

42. Prevention (Catheter Irrigation)
(36) Catheter irrigation with antimicrobials may be
considered in selected patients who undergo
surgical procedures and short-term catheterization
to reduce CA-bacteriuria (C-I).!
!
van den Broek PJ, Daha TJ, Mouton RP. Bladder irrigation with povidone-iodine in prevention of urinary-tract infections !
associated with intermittent urethral catheterisation. Lancet 1985; 1:563–565.!
Ball AJ, Carr TW, Gillespie WA, et al. Bladder irrigation with chlorhexidine for the prevention of urinary infection!
after transurethral operations: a prospective controlled study. J Urol 1987; 138:491–494.

43. Prevention 

(Catheter Irrigation)
(37) Catheter irrigation with normal saline
should NOT be used routinely to reduce CA-
bacteriuria, CA-UTI or obstruction in
patients with long-term indwelling
catheterization (B-II).
Muncie HL Jr, Hoopes JM, Damron DJ, et al. Once-daily irrigation of long-term urethral catheters with normal saline:
lack of benefit. Arch Intern Med 1989; 149:441–443.
Elliott TS, Reid L, Rao GG, et al. Bladder irrigation or irritation?
Br J Urol 1989; 64:391–394.

44. Prevention 

(Antimicrobials in the Drainage Bag)
(38) Routine addition of antimicrobials or
antiseptics to the drainage bag of
catheterized patients should NOT be used to
reduce CA-bacteriuria (A-I) or CA-UTI (A-I).
!
Sweet DE, Goodpasture HC, Holl K, et al. Evaluation of H2O2 prophylaxis of bacteriuria in patients
with long-term indwelling Foley catheters: a randomized, controlled study. Infect Control 1985; 6:263–266.
Gillespie WA, Simpson RA, Jones JE, et al. Does the addition of disinfectant to urine drainage bags
prevent infection in catheterised patients? Lancet 1983; 1:1037–1039.
Reiche T, Lisby G, Jorgensen S, et al. A prospective, controlled, randomized study of the effect of a slow-release
silver device on the frequency of urinary tract infection in newly catheterized patients. BJU Int 2000; 85:54–59.

45. Prevention 

(Routine Catheter Change)
(39) Data are insufficient to make a
recommendation as to whether routine
catheter change (eg, every 2-4 weeks) in
patients with functional long-term indwelling
urethral or suprapubic catheters reduces the
risk of CA-ASB or CA-UTI, even in patients who
experience repeated early catheter blockage
from encrustation.
!
Kunin CM, Chin QF, Chambers S. Indwelling urinary catheters in the elderly: relation of “catheter life”
to formation of encrustations in patients with and without blocked catheters. Am J Med 1987; 82: 405–411.

46. Prevention

(Prophylactic Antimicrobials at Time of Catheter Removal or
Replacement)
(40) Prophylactic antimicrobials, given systemically or by
bladder irrigation, should NOT be administered routinely to
patients at the time of catheter placement to reduce CA-
UTI (A-I) or at the time of catheter-removal (B-I) or
replacement (A-III) to reduce CA-bacteriuria.
!
Romanelli G, Giustina A, Cravarezza P, et al. A single dose of aztreonam in the prevention of urinary tract infections
in elderly catheterized patients. J Chemother 1990; 2:178–181.
Wazait HD, Patel HR, van der Meulen JH, et al. A pilot randomized double-blind placebo-controlled trial on the use of antibiotics
On urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin. BJU Int 2004; 94:1048–1050.
Urinary Catheter Guidelines • CID 2010:50 (1 March) • 663
Schneeberger PM, Vreede RW, Bogdanowicz JF, et al. A randomized study on the effect of bladder irrigation with povidone-iodine
Before removal of an indwelling catheter. J Hosp Infect 1992; 21:223–229.
Pfefferkorn U, Lea S, Moldenhauer J, et al. Antibiotic prophylaxis aturinary catheter removal prevents urinary tract infections:
a prospective randomized trial. Ann Surg 2009; 249:573–575.

47. 47
What should NOT be done for patients with urinary catheters? Strategy Strength of
Recommen-
dation
Level of
Evidence
Use of antibiotic–coated catheters Strong High
Routine use of systemic prophylactic
antibiotics at the time of insertion,
during and upon removal of indwelling urinary
catheters
Strong Moderate
Catheter or bladder irrigation with
antimicrobial agents
Strong High
Routine addition of antibiotics or antiseptics to
drainage bags and antireflux vents and valves
Strong High
Daily meatal care Strong High
Changing of catheters and drainage bags at
arbitrarily fixed intervals
Weak Low

48. 48
How can unnecessary long-term catheterization
be avoided?

Consider using alternative strategies for timely
removal and prevention of unnecessary long-term
catheterization such as instituting automatic stop
orders, nurse-based or electronic physician reminder
systems or chart reminders.
!
Weak recommendation, Moderate quality of evidence

49. 49
UTI Task Force
!
Chair: Mediadora C. Saniel, MD
Co Chair: Marissa M. Alejandria, MD
!
Cluster Heads, Complicated UTI
!
Allan Raymond S. Tenorio , MD
Arthur Dessi E. Roman, MD
Members:
Rufino T. Agudera, MD
Anne Margaret J. Ang, MD
Regina P. Berba, MD
Jill R. Itable, MD
Marie Carmela M. Lapitan. MD
Maria Nicolette M. Mariano, MD
Katha W. Ngo-Sanchez. MD
Oliver S. Sanchez, MD

50. THANK YOU