Use of indwelling catheters and preventing catheter-associated urinary tract infections

2021 ◽  
Author(s):  
Ann Wakefield
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Indwelling Catheters ◽  
Tract Infections

scholarly journals Does cranberry have a role in catheter-associated urinary tract infections?

2017 ◽  
Vol 11 (11) ◽  
pp. E421-4 ◽  
Author(s):  
Dominique Thomas ◽  
Matthew Rutman ◽  
Kimberly Cooper ◽  
Andrew Abrams ◽  
Julia Finkelstein ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Species ◽  
Signs And Symptoms ◽  
Urine Specimen ◽  
Indwelling Catheters ◽  
Resistance Patterns ◽  
Catheter Urine ◽  
Tract Infections

Introduction: Catheter-associated urinary tract infections (CA-UTIs) are a prevalent and costly condition, with very few therapeutic options. We sought to evaluate the efficacy of an oral cranberry supplement on CA-UTIs over a six-month period. Methods: Subjects with long-term indwelling catheters and recurrent symptomatic CA-UTIs were enrolled to take a once-daily oral cranberry supplement with 36 mg of the active ingredient proanthocyanidin (PACs). Primary outcome was reducing the number of symptomatic CA-UTIs. This was defined by ≥103 (cfu)/mL of ≥1 bacterial species in a single catheter urine specimen and signs and symptoms compatible with CA-UTI. Secondary outcomes included bacterial counts and resistance patterns to antibiotics.Results: Thirty-four patients were enrolled in the trial; 22 patients (mean age 77.22 years, 77.27% were men) completed the study. Cranberry was effective in reducing the number of symptomatic CA-UTIs in all patients (n=22). Resistance to antibiotics was reduced by 28%. Furthermore, colony counts were reduced by 58.65%. No subjects had adverse events while taking cranberry.Conclusions: The cranberry supplement reduced the number of symptomatic CA-UTIs, antibiotic resistances, and major causative organisms in this cohort. Larger, placebo-controlled studies are needed to further define the role of cranberry in CA-UTIs.

scholarly journals Enterococcal Biofilm Formation and Virulence in an Optimized Murine Model of Foreign Body-Associated Urinary Tract Infections

2010 ◽  
Vol 78 (10) ◽  
pp. 4166-4175 ◽  
Author(s):  
Pascale S. Guiton ◽  
Chia S. Hung ◽  
Lynn E. Hancock ◽  
Michael G. Caparon ◽  
Scott J. Hultgren
Keyword(s):  
Urinary Tract ◽  
Foreign Body ◽  
Urinary Tract Infections ◽  
Murine Model ◽  
Biofilm Formation ◽  
Significant Advance ◽  
Virulence Determinants ◽  
Indwelling Catheters ◽  
Tract Infections

ABSTRACT Catheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial UTIs and pose significant clinical challenges. Enterococcal species are among the predominant causative agents of CAUTIs. However, very little is known about the pathophysiology of Enterococcus-mediated UTIs. We optimized a murine model of foreign body-associated UTI in order to mimic conditions of indwelling catheters in patients. In this model, the presence of a foreign body elicits major histological changes and induces the expression of several proinflammatory cytokines in the bladder. In addition, in contrast to naïve mice, infection of catheter-implanted mice with Enterococcus faecalis induced the specific expression of interleukin 1β (IL-1β) and macrophage inflammatory protein 1α (MIP-1α) in the bladder. These responses resulted in a favorable niche for the development of persistent E. faecalis infections in the murine bladders and kidneys. Furthermore, biofilm formation on the catheter implant in vivo correlated with persistent infections. However, the enterococcal autolytic factors GelE and Atn (also known as AtlA), which are important in biofilm formation in vitro, are dispensable in vivo. In contrast, the housekeeping sortase A (SrtA) is critical for biofilm formation and virulence in CAUTIs. Overall, this murine model represents a significant advance in the understanding of CAUTIs and underscores the importance of urinary catheterization during E. faecalis uropathogenesis. This model is also a valuable tool for the identification of virulence determinants that can serve as potential antimicrobial targets for the treatment of enterococcal infections.

Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes

2020 ◽  
Vol 41 (8) ◽  
pp. 891-899
Author(s):  
Michael L. Rinke ◽  
Suzette O. Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
Philip Zachariah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Case Control ◽  
Research Network ◽  
Clean Intermittent Catheterization ◽  
Control Analysis ◽  
Indwelling Catheters ◽  
Incidence Risk ◽  
Tract Infections

AbstractObjective:Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.Design:Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.Setting:Five urban, academic medical centers, part of the New York City Clinical Data Research Network.Patients:Potential patients were age <22 years who were seen between October 2010 and September 2015.Results:In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.Conclusions:Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.

Bladder Management and Urinary Tract Infections in Danish Hospitals, Nursing Homes, and Home Care: A National Prevalence Study

1996 ◽  
Vol 17 (4) ◽  
pp. 215-221 ◽  
Author(s):  
Jette Zimakoff ◽  
David J. Stickler ◽  
Birgitte Pontoppidan ◽  
Severin O. Larsen
Keyword(s):  
Urinary Tract Infection ◽  
Regression Analysis ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Indwelling Catheters ◽  
Drainage Systems ◽  
Bladder Management ◽  
Tract Infections ◽  
Hospital Acquired

AbstractObjective:To establish the prevalence of urinary tract infection in patients undergoing various forms of bladder management.Design:A nationwide descriptive point-prevalence survey with logistic regression analysis of the data relating infection to bladder management.Setting:Fifteen hospitals, 21 nursing homes, and 13 home care districts throughout Denmark.Patients:Information was collected on 3,665 patients. On the day of the study, 349 patients had indwelling catheters and 1,150 were using external urine drainage systems (condoms or diapers) for bladder management.Results:The prevalence of urinary tract infections in catheterized patients and those using external drainage systems was 13.2% and 8.1%, respectively. The prevalence of hospital-acquired urinary tract infection (4.2%) had not changed from that reported in 1978. The proportion of these infections related to the indwelling catheter, however, had reduced from 66% to 30%. Logistic regression analysis confirmed that, when corrected for the patient-related confounders (female gender, age >60 years, incontinence, immobility, and stay in hospital for longer than 15 days), condoms (odds ratio [OR], 5.94; 95% confidence interval [CI95], 2.8 to 12.5), indwelling catheters (OR, 3.3; CI95, 2.3 to 4.8), and diapers (OR, 1.5; CI95, 1.1 to 2.1) were significantly (P<.001, P<.001, and P=.008, respectively) related to infection.Conclusions:Prevalence surveys have revealed that over the period 1978 to 1991, during which efforts have been made to restrict the use of indwelling catheters and to encourage the care of catheterized patients according to guidelines recommended by the Danish National Centre for Hospital Hygiene, the percentage of hospital-acquired urinary tract infections associated with indwelling catheters has been halved. External urine drainage systems, however, have emerged as significant risk factors for urinary tract infection.

Instillation of 3% Hydrogen Peroxide or Distilled Vinegar in Urethral Catheter Drainage Bag to Decrease Catheter-Associated Bacteriuria

2001 ◽  
Vol 3 (2) ◽  
pp. 78-87 ◽  
Author(s):  
Eric A. Washington
Keyword(s):  
Hydrogen Peroxide ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Nursing Practice ◽  
Drainage System ◽  
Urethral Catheter ◽  
Catheter Drainage ◽  
Indwelling Catheters ◽  
Significant Difference ◽  
Tract Infections

Patients with indwelling catheters acquire urinary tract infections at a rate of5% per day. After 30 days of catheterization, there is a 78% to 95% incidence of bacteriuria, despite the use of meticulous catheter care. Research studies on reducing the development of bacteriuria have focused on the propagation of bacteria within the catheter drainage bag. This research proposal sought to determine the effects of instillation of 3% hydrogen peroxide versus distilled vinegar in urethral catheter drainage bags to decrease bacteriuria in 20 long-termcatheterized patients. Baseline urine cultures for control and test mediums showed no significant difference in rates of bacteriuria. However, urine cultures obtained at the 48-hour interval showed significant reduction in bacteriuria in urinary bags irrigated with vinegar. The implications this study has for nursing practice include a need for further research using a larger number of subjects and a need for improvements in the design of the catheter drainage system.

scholarly journals Compared with Cotrimoxazole Nitroxoline Seems to Be a Better Option for the Treatment and Prophylaxis of Urinary Tract Infections Caused by Multidrug-Resistant Uropathogens: An In Vitro Study

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 645
Author(s):  
Ulrich Dobrindt ◽  
Haleluya T. Wami ◽  
Torsten Schmidt-Wieland ◽  
Daniela Bertsch ◽  
Klaus Oberdorfer ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Multidrug Resistant ◽  
Indwelling Catheters ◽  
Structural Characterisation ◽  
Phenotypic Resistance ◽  
E Coli ◽  
Multiresistant Bacteria ◽  
Tract Infections

The resistance of uropathogens to various antibiotics is increasing, but nitroxoline remains active in vitro against some relevant multidrug resistant uropathogenic bacteria. E. coli strains, which are among the most common uropathogens, are unanimously susceptible. Thus, nitroxoline is an option for the therapy of urinary tract infections caused by multiresistant bacteria. Since nitroxoline is active against bacteria in biofilms, it will also be effective in patients with indwelling catheters or foreign bodies in the urinary tract. Cotrimoxazole, on the other hand, which, in principle, can also act on bacteria in biofilms, is frequently inactive against multiresistant uropathogens. Based on phenotypic resistance data from a large number of urine isolates, structural characterisation of an MDR plasmid of a recent ST131 uropathogenic E. coli isolate, and publicly available genomic data of resistant enterobacteria, we show that nitroxoline could be used instead of cotrimoxazole for intervention against MDR uropathogens. Particularly in uropathogenic E. coli, but also in other enterobacterial uropathogens, the frequent parallel resistance to different antibiotics due to the accumulation of multiple antibiotic resistance determinants on mobile genetic elements argues for greater consideration of nitroxoline in the treatment of uncomplicated urinary tract infections.

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