Catheterization indwelling

An indwelling catheter is commonly used in various health care settings, and is associated with UTIs. Bacteria may be introduced into the bladder via the catheter in several ways. These include direct infection introduction during catheterization (via colonization and subsequently traveling the length of the catheter through bacterial motility or capillary action). UTIs as a result of an indwelling catheter are common and occur at a rate of 5% per day of catheter presence.25... 

The approach in the setting of a patient with bacteriuria and an indwelling urinary catheter follows two paths. The first, in asymptomatic patients with catheterization, is to hold antibiotics and remove the catheter if possible. The second as in the above-described patient who subsequently becomes symptomatic, antibiotics should then commence with removal of the catheter if possible. In both of the above situations, if discontinuation of the catheter is not possible, the patient should be re-catheterized with a new urinary catheter if the previous catheter is greater than 2 weeks old. 

Antibiotic prophylaxis is warranted in high-risk patients (e.g., prolonged indwelling catheterization, positive urine cultures, and neutropenia) undergoing transurethral, perineal, or suprapubic resection of the prostate, resection of bladder tumors, or cystoscopy. 

The urinary pathogens in complicated or nosocomial infections may include E colt, which accounts for less than 50% of these infections, Proteus spp., Klebsiella pneumoniae, Enterobacter spp.. Pseudomonas aeruginosa, staphylococci, and enterococci. Candida spp. have become common causes of urinary infection in the critically ill and chronically catheterized patient. The majority of UTIs are caused by a single organism however, in patients vrith stones, indwelling urinary catheters, or chronic renal abscesses, multiple organisms may be isolated. 

If intermittent catheterization is not possible, surgical placement of a suprapubic catheter may be necessary. The use of a chronic indwelling catheter should be avoided because of the increased occurrence of urinary tract infections and nephrolithiasis. 

The use of an indwelling catheter frequently is associated with infection of the urinary tract and represents the most common cause of hospital-acquired infection. The incidence of catheter-associated infection is related to a variety of factors, including method and duration of catheterization, the catheter system (open or closed), the care of the system, the susceptibility of the patient, and the technique of the health care personnel inserting the catheter. The incidence of infection from a single catheterization in a healthy ambulatory patient is 1%. Bacteria may enter the bladder in a number of ways. During the catheterization, bacteria may be introduced directly into the bladder from the urethra. Once the catheter is in place, bacteria may pass up the lumen of the catheter via the movement of air bubbles, by motility of the bacteria, or by capillary action. In addition, bacteria may reach the bladder from around the exudative sheath that surrounds... 

Patients with indwelling catheters acquire UTIs at a rate of 5% per day. The closed systems are capable of preventing bacteri-uria in most patients for up to 10 days with appropriate care. After 30 days of catheterization, however, there is a 78% to 95% incidence of bacteriuria despite use of a closed system. Unfortunately, UTI symptoms in catheterized patient are not clearly defined. Fever, peripheral leukocytosis, and urinary signs and symptoms may be of little predictive value. When bacteriuria occurs in the asymptomatic, short-term catheterized patient (<30 days), the use of systemic antibiotics should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should be removed and treatment as described for complicated infections started. The optimal duration of therapy is not known. In the long-term catheterized patient (>30 days), bacteriuria is inevitable. The administration of... 

Macleod, J. N., and B. H. Shapiro. 1988. Repetitive blood sampling in unrestrained and unstressed mice using a chronic indwelling right atrial catheterization apparatus. lM.boratory Animal Science 38 603-608. 

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