Quality of Care/Patient Safety

Duration of catheterization and other factors increase the likelihood of catheter-related urinary tract infection

Hospital-acquired urinary tract infection (UTI) due to urinary catheters carries an almost three-fold increased risk of death, even when other factors are considered. In a study supported by the Agency for Healthcare Research and Quality (HS11540), University of Michigan Health System researchers Sanjay Saint, M.D., M.P.H., and Carol E. Chenoweth, M.D., examined factors that increase the risk of catheter-related UTI and proper management of such infections. They point out that urinary catheters develop biofilms (a collection of microbial organisms surrounded by a matrix of primarily polysaccharide materials) on their inner and outer surfaces once they are inserted. The biofilm allows microbes to attach to catheter surfaces in a way that makes it difficult to remove them with gentle rinsing.

Because the most important risk factor for UTI is duration of catheterization, the researchers recommend that indwelling urethral catheterization be avoided or at least limited whenever possible. Additional methods to prevent catheter-related UTI include aseptic insertion and maintenance, use of a closed drainage system, anti-infective catheters in patients at high risk of infection, and use of systemic antibiotics in select patients.

Alternative urinary collection strategies may be appropriate in certain patient groups. Specifically, condom catheters should be considered in men likely to comply with this urinary collection method, suprapubic catheters should be considered in patients requiring long-term indwelling drainage, and intermittent catheterization may be appropriate in patients with injured spinal cords. The investigators call for more research on additional methods for preventing this common hospital infection, which entails an average cost of $558 to $676 per episode.

More details are in "Biofilms and catheter-associated urinary tract infections," by Drs. Saint and Chenoweth, in Infectious Disease Clinics of North America 17, pp. 411-432, 2003.

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