Preventing Catheter-Associated Urinary Tract Infections

Laura A. Stokowski, RN, MS

Disclosures

February 03, 2009

Antibiotics and CAUTI

Most experts agree that asymptomatic bacteriuria or funguria does not warrant antimicrobial therapy.[10] It has even been suggested that the term CAUTI should not be used in asymptomatic patients because it implies infection that should be treated.[10] Symptomatic CAUTI, with fever, leukocytosis, or suprapubic discomfort, with a positive urine culture, is treated. There is weak evidence that prophylactic antibiotics, rather than antibiotics when clinically or microbiologically indicated, reduce the rate of bacteriuria and signs of infection in patients with short- or long-term urinary catheters.[48] Nevertheless, possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic-resistant bacteria.

Recognizing the dangers of systemic antibiotics, manufacturers of urinary catheters have impregnated some devices with silver or other antimicrobial substances. The evidence for a reduction of infection with antiseptic-impregnated catheters used for long-term bladder drainage is considered insufficient to recommend their routine use.[49] A major problem with current data is that the magnitude of the outcome varied greatly among studies.[50] Adequately powered randomized controlled trials, with intention-to-treat analyses, are needed to assess the clinical effectiveness and cost- effectiveness of currently marketed antimicrobial catheters coated with a silver alloy or nitrofurazone.[50] Head-to-head trials of different catheter types are also needed.[50]

Conclusion

With the end of reimbursement for costs associated with CAUTI, hospitals are eager to prevent or reduce their incidence of this condition, and are examining their urinary catheter management practices.[44] Evidence-based guidelines are available, but not universally followed. Understanding and educating nurses about the pathogenesis of CAUTI is an important first step in the prevention of this common healthcare-associated infection.

The Society of Urologic Nurses and Associates is a professional organization committed to excellence in clinical practice and research through education of its members, patients, family and community. SUNA's vision is to be the nursing authority in the management of persons with urologic healthcare concerns. For more information, visit www.suna.org.

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