Skip to main content
SpringerLink
Log in

Chronic Catheter Associated Complications and Catheter-Associated Urinary Tract Infection

  • Chapter
  • First Online:
Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly

Abstract

Catheter-associated urinary tract infection (CAUTI) is common, costly, and is associated with significant patient morbidity, particularly with chronic indwelling urinary catheters. There has been an increased focus on the prevention of CAUTI since the Centers for Medicare and Medicaid Services instituted nonreimbursement for CAUTI. Interpretation of many studies of CAUTI is impeded by the failure to distinguish between symptomatic and asymptomatic bacteriuria. Consensus guidelines for the diagnosis, prevention, and treatment of CAUTI have been published by multiple organizations. However, a single, evidence-based approach to the diagnosis of urinary tract infection does not exist. Biofilms play a unique role in the pathogenesis of CAUTI and are associated with pathogens with a high propensity toward multidrug resistant organisms. Duration of urinary catheterization is the most important risk factor for CAUTI. Avoiding placement of indwelling catheters and promoting early removal of the catheter when appropriate are the most effective interventions to prevent CAUTI. Many aspects of the management of CAUTI merit further study. Practical strategies are needed to ensure effective use of proven infection prevention and ameliorate the burden of disease associated with indwelling urinary catheterization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Edwards JR, Peterson KD, Andrus ML, Tolson JS, Goulding JS, Dudeck MA, Mincey RB, Pollock DA, Horan TC; NHSN Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control. 2007; 35(5):290–301.

    Google Scholar 

  2. Klevens RM, Edward JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007; 122(2):160–6.

    Google Scholar 

  3. Klevans RM, Edwards JR, Gaynes RP, National Nosocomial Infections Surveillance System. The impact of antimicrobial-resistant, health care-associated infections on mortality in the United States. Clin Infect Dis. 2008;47(7):927–30.

    Article  Google Scholar 

  4. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319–26.

    Google Scholar 

  5. Wald HL, Kramer AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA. 2007;298(23):2782–4.

    Article  CAS  PubMed  Google Scholar 

  6. Nicolle LE. Catheter-acquired urinary tract infection: the once and future guidelines. Infect Control Hosp Epidemiol. 2010;31(4):327–9.

    Article  PubMed  Google Scholar 

  7. Saint S, Lipsky BA, Baker PD, McDonald LL, Ossenkop K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc. 1999;47(12):1453–7.

    Article  CAS  PubMed  Google Scholar 

  8. Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med. 2002;137(2):125–7.

    Article  PubMed  Google Scholar 

  9. Saint S, Olmsted RN, Fakih MG, Kowalski CP, Watson SR, Sales AE, Krein SL. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf. 2009;35(9):449–55.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Benoit SR, Nsa W, Richards CL, Bratzler DW, Shefer AM, Steele LM, Jernigan JA. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc. 2008;56(11):2039–44.

    Article  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention (CDC). Urinary tract infection (UTI) event for long-term care facilities. [Internet] 2012 Aug 24. Available from: http://www.cdc.gov/nhsn/PDFs/LTC/LTCF-UTI-protocol_FINAL_8-24-2012.pdf.

  12. Morgan DJ, Meddings J, Saint S, Lautenbach E, Shardell M, Anderson D, Milstone AM, Drees M, Pineles L, Safdar N, Bowling J, Henderson D, Yokoe D, Harris AD; SHEA Research Network. Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? Clin Infect Dis. 2012;55(7):932–9.

    Google Scholar 

  13. Saint S, Meddings JA, Calfee D, Kowalski CP, Krein SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med. 2009;150(12):877–84.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Trautner BW. Management of catheter-associated urinary tract infection. Curr Opin Infect Dis. 2010;23(1):76–82.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Trautner BE, Darouiche RO. Role of biofilm in catheter-associated urinary tract infection. Am J Infect Control. 2004;32(3):117–83.

    Article  Google Scholar 

  16. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160(5):678–82.

    CAS  PubMed  Google Scholar 

  17. Rowe TA, Juthani-Mehta M. Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin N Am. 2014;28(1):75–89.

    Article  Google Scholar 

  18. Dalen DM, Zvonar RK, Jessamine PG. An evaluation of the management of asymptomatic catheter-associated bacteriuria and candiduria at The Ottawa Hospital. Can J Infect Dis Med Microbiol. 2005;16(3):166–70.

    PubMed  PubMed Central  Google Scholar 

  19. Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006;74(6):985–90.

    PubMed  Google Scholar 

  20. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging health. 2013;9(5). doi: 10.2217/ahe.13.28.

  21. Midthun SJ. Criteria for urinary tract infection in the elderly: variables that challenge nursing assessment. Urol Nurs. 2004;24(3):157–62, 166–9, 186.

    Google Scholar 

  22. Genao L, Buhr G. Urinary tract infections in older adults residing in long-term care facilities. Ann Longterm Care. 2012;20(4):33–8.

    PubMed  PubMed Central  Google Scholar 

  23. Fleming A, Browne J, Byrne S. The effect of interventions to reduce potentially inappropriate antibiotic prescribing in long-term care facilities: a systematic review of randomized controlled trials. Drugs Aging. 2013;30(6):401–8.

    Article  CAS  PubMed  Google Scholar 

  24. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinks PJ, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer Criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77.

    Google Scholar 

  25. Vergidis P, Patel R. Novel approaches to the diagnosis, prevention, and treatment of medical device-associated infections. Infect Dis Clin North Am. 2012;26(1):173–86.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Smith PW, Bennett G, Bradley, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K; Society for Healthcare Epidemiology of America (SHEA); Association for Professionals in Infection Control and Epidemiology (APIC). SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control. 2008;36(7):504–35.

    Google Scholar 

  27. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambyah PA, Tenke P, Nicolle LE, Infectious Diseases of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–63.

    Article  PubMed  Google Scholar 

  28. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinks PJ, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer Criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77.

    Google Scholar 

  29. Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, McGeer A, Muder RR, Mylotte J, Nicolle LE, Nurse B, Paton S, Simon AE, Smith P, Strausbaugh L. Development of minimum criteria for the initiation of antibiotics in residents of long-term care facilities: results of a consensus conference. Infect Control Hosp Epidemiol. 2001;22(2):120–4.

    Article  CAS  PubMed  Google Scholar 

  30. Gray M, Newman DK, Einhorn CJ, Reid-Czarapata BJ. Expert review: best practices in managing the indwelling catheter. Perspectives 2006;1–11 (Special Edition).

    Google Scholar 

  31. Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Tambyah PA, Oon J. Catheter-associated urinary tract infection. Curr Opin Infect Dis. 2012;25(4):365–70.

    Article  PubMed  Google Scholar 

  33. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol. 2002;23(1):27–31.

    Article  PubMed  Google Scholar 

  34. Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997;25(1):609–22.

    Article  Google Scholar 

  35. Chenoweth CE, Saint S. Urinary tract infections. Infect Dis Clin North Am. 2011;25(1):103–15.

    Article  PubMed  Google Scholar 

  36. Newman DK. The indwelling urinary catheter: principles for best practice. J Wound Ostomy Continence Nurs. 2007;34(6):655–61.

    Article  PubMed  Google Scholar 

  37. Leone M, Albanese J, Garnier F, Sapin C, Barrau K, Bimar MC, Martin C. Risk factors for nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med. 2003;29(7):1077–80.

    Article  PubMed  Google Scholar 

  38. Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am J Infect Control. 2007;35(9):589–93.

    Article  PubMed  Google Scholar 

  39. Holyrod-Leduc JM, Sen S, Bertenthal D, Sands LP, Palmer RM, Kresevic DM, Covinsky KE, Landefeld SC. The relationship of indwelling urinary catheters to death, length of hospital stay, functional decline, and nursing home admission in hospitalized older medical patients. J Am Geriatr Soc. 2007;55(2):227–33.

    Article  Google Scholar 

  40. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28(1):68–75.

    Article  CAS  PubMed  Google Scholar 

  41. Hampton T. Urinary catheter use often “inappropriate” in hospitalized elderly patients. JAMA. 2006;295(24):2838.

    CAS  PubMed  Google Scholar 

  42. Hazelett SE, Tsai M, Gareri M, Allen K. The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatr. 2006;6:15.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hanchett M. Preventing CAUTI: a patient-centered approach. Prevention Strategist Autumn 2012;442–50.

    Google Scholar 

  44. Lo E, Nicolle L, Classen D, Arias KM, Podgorny K, Anderson DJ, Bursstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Marshall J, Mermel LA, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S41–50.

    Article  PubMed  Google Scholar 

  45. Association for Professionals in Infection Control and Epidemiology (APIC). Guide to the elimination of catheter-associated urinary tract infections (CAUTIs). Developing and applying facility-based prevention intervention in acute and long-term care settings. An APIC Guide [Internet]. 2008 [cited 2013 Dec 6]. Available from: http://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf.

  46. Conway LJ, Pogorzelska M, Larson E, Stone PW. Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units. Am J Infect Control. 2012;40(8):705–10.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Saye DE. Recurring and antimicrobial resistant infections: considering the potential role of biofilms in clinical practice. Ostomy Wound Manage. 2007;53(4):46–8, 50, 52.

    Google Scholar 

  48. Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis. 2001;7(2):277–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Stickler DJ, Morgan SD. Observations on the development of crystalline bacterial biofilms that encrust and block Foley catheters. J Hosp Infect. 2008;69(4):350–60.

    Article  CAS  PubMed  Google Scholar 

  50. Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract Urol. 2008;5(11):598–608.

    Article  CAS  PubMed  Google Scholar 

  51. Tambyah PA. Catheter-associated urinary tract infections: diagnosis and prophylaxis. Int J Antimicrob Agents. 2004;24 Suppl 1:S44–8.

    Article  PubMed  Google Scholar 

  52. Stickler DJ, Feneley RC. The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control. Spinal Cord. 2010;48(11):784–90.

    Article  CAS  PubMed  Google Scholar 

  53. Jacobsen SM, Shirtliff ME. Proteus mirabilis biofilms and catheter-associated urinary tract infections. Virulence. 2011;2(5):460–5.

    Article  PubMed  Google Scholar 

  54. Barford JM, Anson K, Hu Y, Coates AR. A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip. BJU Int. 2008;102(1):67–74.

    Article  PubMed  Google Scholar 

  55. Drekonja DM, Johnson JR. Urinary tract infections. Prim Care. 2008;35(2):345–67.

    Article  PubMed  Google Scholar 

  56. Liedl B. Catheter-associated urinary tract infections. Curr Opin Urol. 2001;11(1):75–9.

    Article  CAS  PubMed  Google Scholar 

  57. Stickler DJ. Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done. J Intern Med. 2014. doi:10.1111/joim.12220.

  58. Tenke P, Koves B, Nagy K, Hultgren SJ, Mendling W, Wullt B, Grabe M, Wagenlehner FM, Cek M, Pickard R, Botto H, Naber KG, Bjerklund Johansen TE. Update on biofilm infections in the urinary tract. World J Urol. 2012;30(1):51–7.

    Article  PubMed  Google Scholar 

  59. Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a mid-western community teaching hospital. Am J Infect Control. 2004;32(4):196–9.

    Article  PubMed  Google Scholar 

  60. Bernard MS, Hunter KF, Moore KN. A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urol Nurs. 2012;32(1):29–37.

    PubMed  Google Scholar 

  61. Drinka PJ. Complications of chronic indwelling urinary catheters. J Am Med Dir Assoc. 2006;7(6):388–92.

    Article  PubMed  Google Scholar 

  62. Nicolle LE. Catheter-related urinary tract infection. Drugs Aging. 2005;22(8):627–39.

    Article  PubMed  Google Scholar 

  63. Warren JW, Damron D, Tenney JH, Hoopes JM, Deforge B, Muncie Jr HR. Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis. 1987;155(6):1151–8.

    Article  CAS  PubMed  Google Scholar 

  64. Orr PH, Nicolle LE, Duckworth H, Brunka J, Kennedy J, Murray D, Harding GK. Febrile urinary infection in the institutionalized elderly. Am J Med. 1996;100(1):71–7.

    Article  CAS  PubMed  Google Scholar 

  65. Ouslander JG, Greengold B, Chen S. Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study. J Urol. 1987;138(5):1191–5.

    CAS  PubMed  Google Scholar 

  66. Chenoweth CE, Gould CV, Saint S. Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin North Am. 2014;28(1):105–19.

    Article  PubMed  Google Scholar 

  67. Fakih MG, Dueweke C, Meisner S, Berriel-Cass D, Savoy-Moore R, Brach N, Rey J, DeSantis L, Saravolatz LD. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol. 2008;29(9):815–9.

    Article  PubMed  Google Scholar 

  68. Cornia PB, Lipsky BA. Commentary: indwelling urinary catheters in hospitalized patients: when in doubt, pull it out. Infect Control Hosp Epidemiol. 2008;29(9):820–2.

    Article  PubMed  Google Scholar 

  69. Neil-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev. 2005;3, CD005428.

    Google Scholar 

  70. Niel-Weise BS, van den Broek PJ, da Silva EM, Silva LA. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev. 2012;8, CD004201.

    Google Scholar 

  71. Moore KN, Fader M, Getliffe K. Long-term bladder management by intermittent catheterization in adults and children. Cochrane Database Syst Rev. 2007;4, CD006008.

    Google Scholar 

  72. Griffiths R, Fernandez R. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev. 2007;2, CD004011.

    Google Scholar 

  73. Niel-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev. 2005;3, CD004203.

    Google Scholar 

  74. Cools HJM, van der Meer JWM. Restriction of long-term indwelling urethral catheterization in the elderly. Br J Urol. 1986;58(6):683–8.

    Article  CAS  PubMed  Google Scholar 

  75. Hebel JR, Warren JW. The use of urethral, condom, and suprapubic catheters in aged nursing home patients. J Am Geriatr Soc. 1990;38(7):777–84.

    Article  CAS  PubMed  Google Scholar 

  76. Nicolle LE. The chronic indwelling catheter and urinary infection in long-term-care facility residents. Infect Control Hosp Epidemiol. 2001;22(5):316–21.

    Article  CAS  PubMed  Google Scholar 

  77. Tambyah PA, Maki DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med. 2000;160(5):673–7.

    CAS  PubMed  Google Scholar 

  78. Steward DK, Wood GL, Cohen RL, Smith JW, Machowiak PA. Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long-term urinary catheters. Am J Infect Control. 1985;13(4):159–60.

    Article  Google Scholar 

  79. Madigan E, Neff DF. Care of patients with long-term indwelling urinary catheters. Online J Issues Nurs. 2003;8(3):7.

    PubMed  Google Scholar 

  80. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000;61(2):369376.

    Google Scholar 

  81. Vance J. Diagnosing and managing urinary tract infections: myths, mysteries and realities. Caring Ages. 2002;3(10):18–21.

    Google Scholar 

  82. Wilde MH, Carrigan MJ. A chart audit of factors related to urine flow and urinary tract infection. J Adv Nurs. 2003;43(3):254–62.

    Article  PubMed  Google Scholar 

  83. Cornia PB, Amory JK, Fraser S, Saint S, Lipsky BA. Computer-based order entry decreased duration of indwelling urinary catheterization in hospitalized patients. Am J Med. 2003;114(5):404–7.

    Article  PubMed  Google Scholar 

  84. Resar R, Griffin FA, Haraden C, Nolean TW. Using care bundles to improve health care quality. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012. [Internet]. [cited 2013 Dec 6]; Available from: http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx.

  85. Clark K, Tong D, Pan Y, Easley KA, Norrick B, Ko C, Wang A, Razavi B, Stein J. Reduction in catheter-associated urinary tract infections by bundling interventions. Int J Quality Health Care. 2013;25(1):43–9.

    Article  Google Scholar 

  86. Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart Lung. 2012;41(3):271–83.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    JoAnn Coleman

Authors
  1. JoAnn Coleman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to JoAnn Coleman .

Editor information

Editors and Affiliations

  1. Division of Pelvic NeuroScience, Department of Surgery, The Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    David A. Gordon

  2. Sinai Center for Geriatric Surgery, Department of Surgery, Sinai Hospital, Baltimore, Maryland, USA

    Mark R. Katlic

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media New York

About this chapter

Cite this chapter

Coleman, J. (2017). Chronic Catheter Associated Complications and Catheter-Associated Urinary Tract Infection. In: Gordon, D., Katlic, M. (eds) Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6554-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-6554-0_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-6552-6

  • Online ISBN: 978-1-4939-6554-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation