Antibiotic Therapy

Abstract

Infection of the urinary tract is the most common infection to be acquired in hospital and many episodes are associated with instrumentation or manipulation of the urinary tract, usually catheterisation. The development of urinary tract infection during bladder catheterisation has been shown to be associated with an increase in mortality in hospital patients, some as a result of bacteraemia (Piatt et al. 1982). Furthermore, the most common localised focus of infection leading to septicaemia in hospital is the urinary tract (Fig. 14.1) (Eykyn et al. 1990; Meers et al. 1980) and outside hospital, in the community, the urinary tract is second in frequency only to the respiratory tract as the focus of infection leading to septicaemia (Eykyn et al. 1990). The infections associated with the use of urinary catheters and endoscopic instruments for transurethral surgery are of particular concern for the urologist. Infection follows the insertion of penile and testicular implants and artificial urinary sphincters less often, but when it occurs the results may be disastrous. In this chapter we shall consider infections associated with urinary catheters and urological prosthetic devices and discuss their pathogenesis, treatment and prevention.