What steps can be taken to reduce the risk of catheter-associated urinary tract infection (CAUTI) in men?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

At least 7 steps can be taken to prevent CAUTIs. However, although these steps can postpone a UTI for weeks, they will not be totally successful in patients with long-term catheterization.

Step 1

Catheterization should be avoided when not required (catheters have been found to be unnecessary in 41-58% of patient days) and should be terminated as soon as possible.

Step 2

Suprapubic catheters are associated with a lower risk of UTI. For men who require long-term catheterization, local genitourinary complications (meatal erosion, prostatitis, epididymitis) may be reduced and patients may be more satisfied, but mechanical complications are increased. Contraindications include bleeding disorders, previous lower abdominal surgery or irradiation, and morbid obesity.

Step 3

Condom catheters are also associated with a lower risk of bacteriuria than are indwelling catheters, as long as the catheter is not manipulated frequently. However, these are difficult to use in uncircumcised men.

Step 4

Most patients using intermittent catheterization become bacteriuric within a few weeks. The incidence rate is 1-3% per insertion.

Step 5

Aseptic indwelling catheter insertion, a properly maintained closed-drainage system (with ports in the distal catheter for needle aspiration of urine [24] ), and unobstructed urine flow are essential. Catheters with hydrophilic coatings reduce or delay the onset of bacteriuria and are more comfortable for the patient. Only properly trained individuals who are skilled in the correct technique of aseptic catheter insertion and maintenance should take on this task. [25]

Step 6

Urinary catheters coated with silver also reduce the risk of CAUTI. Silver alloy seems to be more effective than silver oxide, and using these more expensive catheters in patients who are at highest risk is reasonable. [26]

Step 7

Because many CAUTIs occur in clusters, good handwashing before and after catheter care is essential.

See Urinary Catheterization in Men and Urinary Catheterization in Women for procedural information on catheterization.


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