New strategies to prevent catheter-associated urinary tract infections

Abstract

Catheter-associated urinary tract infection (CAUTI) is the most common health-care-associated infection worldwide. Although not all cases of bacteriuria result in clinical infection, several hundred thousand episodes of CAUTI occur each year in the USA alone. The milieu in which the catheter is placed is highly conducive to bacterial colonization, biofilm formation on the catheter surface, and inevitable catheter-associated bacteriuria. A multitude of novel methods of CAUTI prevention have been described, including established approaches that are routinely recommended, such as the use of a secured, closed, silicone urinary catheter drainage system that mimics normal voiding, and newer strategies focusing on biocompatible catheter materials that cause minimal host inflammatory response and retard biofilm formation. Much recent research has focused on modification of the catheter surface by either coating or impregnation with antimicrobials or antiseptics. However, clinical trials that analyse cost-effectiveness and rates of antimicrobial resistance are awaited. More recently, innovative use of iontophoresis, vibroacoustic stimulation, bacterial interference and bacteriophage cocktails has been reported.

Key Points

  • Catheter-associated urinary tract infection (CAUTI) is the most common health-care-associated infection in the USA and worldwide

  • There is significant heterogeneity and overlap in the definitions of CAUTI, catheter-associated asymptomatic bacteriuria and catheter-associated bacteriuria

  • Prevention of CAUTI is predominantly based on reviewing the criteria for appropriate placement and early removal of catheters

  • The design of the indwelling urinary catheter remains largely unchanged since its inception

  • New strategies to prevent CAUTI must be based on a comprehensive understanding of the pathogenesis and key factors that influence the development of the infection

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Figure 1: Urinary bladder with an indwelling urinary catheter.

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D. M. Siddiq and R. O. Darouiche contributed equally to researching data for the article, discussion of content, writing and reviewing the manuscript before submission.

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Correspondence to Danish M. Siddiq.

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Siddiq, D., Darouiche, R. New strategies to prevent catheter-associated urinary tract infections. Nat Rev Urol 9, 305–314 (2012). https://doi.org/10.1038/nrurol.2012.68

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