-
Annals of Internal Medicine Oct 2019Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI). (Observational Study)
Observational Study
BACKGROUND
Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI).
OBJECTIVE
To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI).
DESIGN
Prospective, national, nonrandomized, clustered, externally facilitated, pre-post observational quality improvement initiative, for 3 cohorts active between November 2016 and May 2018.
SETTING
Acute care, long-term acute care, and critical access hospitals, including intensive care and non-intensive care wards.
PARTICIPANTS
Target hospitals had a high burden of Clostridioides difficile infection plus central line-associated bloodstream infection, CAUTI, or hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection, defined as cumulative attributable differences above the first tertile in the Targeted Assessment for Prevention (TAP) strategy. Some additional nonrecruited hospitals also joined.
INTERVENTION
Multimodal intervention, including Practice Change Assessment tool to identify infection prevention and control (IPC) and HAI prevention gaps; Web-based, on-demand modules involving onboarding, foundational IPC practices, HAI-specific 2-tiered approach to prioritize and implement interventions, and TAP resources; monthly webinars; state partner-led in-person meetings; and feedback. State partners made site visits to at least 50% of their enrolled hospitals, to support self-assessments and coach.
MEASUREMENTS
Rates of CAUTI and urinary catheter device utilization ratio.
RESULTS
Of 387 participating hospitals from 23 states and the District of Columbia, 361 provided CAUTI data. Over the study period, the unadjusted CAUTI rate was low and relatively stable, decreasing slightly from 1.12 to 1.04 CAUTIs per 1000 catheter-days. Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the postintervention period.
LIMITATIONS
The intervention period was brief, with no assessment of fidelity. Baseline CAUTI rates were low. Patient characteristics were not assessed.
CONCLUSION
This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization.
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention.
Topics: Catheter-Related Infections; Cross Infection; Formative Feedback; Hospital Administration; Hospitals; Humans; Infection Control; Prospective Studies; Quality Improvement; United States; Urinary Catheters; Urinary Tract Infections
PubMed: 31569231
DOI: 10.7326/M18-3534 -
Archivos Espanoles de Urologia Jul 2021Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with...
OBJECTIVE
Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with indwelling urinary catheters.
METHODS
We are presenting a case of a 72 years old male with Bricker urinary derivation with an ureteral catheter. During the follow up, catheteral calcification and encrusted pyelitis were found in TC images and cultures were positive for Corynebacteirum Urealitycum. This condition was managed with endoscopic and medical treatment; that consisted in antibiotics and acidification of urine through nephrostomy tube using an acidifying irrigation solution and Lit-Control pH Down orally, in order to avoid new infections.
RESULTS
Treatment was effective, no new reinfections were shown with the use of Lit-Control pH Down for the maintenance.
CONCLUSIONS
The suspected diagnosis and the early treatment of encrusted pyelitis avoid complications. Antibiotics and urine acidification are key in the treatment of this disease.
Topics: Aged; Corynebacterium; Corynebacterium Infections; Humans; Male; Pyelitis; Urinary Catheters
PubMed: 34219065
DOI: No ID Found -
BMJ Open Feb 2023This meta-analysis aimed to evaluate the effect of bladder training by clamping on bladder urethral function in patients with indwelling urinary catheters used for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This meta-analysis aimed to evaluate the effect of bladder training by clamping on bladder urethral function in patients with indwelling urinary catheters used for different durations.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
The UpToDate, Cochrane Library, OVID, PubMed, China National Knowledge Infrastructure, CINAHL and Embase were screened from 1 January 2000 to 28 February 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials (RCTs) or quasi-experimental designs comparing the efficacy of bladder training in patients with an indwelling urinary catheter by clamping or free drainage before urinary catheter removal were published in English or Chinese.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted the data and assessed the quality of studies. Continuous variables were analysed using mean difference and standardised mean difference (SMD) values with a 95% CI. Categorical variables were analysed using relative risk (RR) and 95% CI.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was urinary tract infection incidence, and secondary outcomes included hours to first voiding, incidence of urinary retention and recatheterisation and residual urine volume.
RESULTS
Seventeen papers (15 RCTs and 2 quasi-RCTs) comprising 3908 participants were included in the meta-analysis. The pooled results of the meta-analysis showed that the clamping group had a significantly higher risk of urinary tract infections (RR=1.47; 95% CI 1.26 to 1.72; p<0.00001) and a longer hour to first void (SMD=0.19; 95% CI 0.08 to 0.29; p=0.0004) compared with the free drainage group. Subgroup analysis of indwelling urinary catheter use durations of ≤7 days indicated that clamping significantly increased the risk of urinary tract infection (RR=1.69; 95% CI 1.42 to 2.02, p<0.00001) and lengthens the interval to first void (SMD=0.26, 95% CI 0.11 to 0.41, p=0.0008) compared with free drainage.
CONCLUSIONS
Bladder training by clamping indwelling urinary catheters increases the incidence of urinary tract infection and lengthens the hours to first void in patients with indwelling urinary catheters use durations of ≤7 days compared with the free drainage. However, the effect of clamping training on patients with an indwelling urinary catheter use duration of >7 days is unclear.
Topics: Humans; Urinary Catheters; Urinary Catheterization; Catheters, Indwelling; Urinary Tract Infections; Urination
PubMed: 36792329
DOI: 10.1136/bmjopen-2022-064075 -
Ugeskrift For Laeger May 2021Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with... (Review)
Review
Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with the potential consequences of prolonging the post-operative course. Effective treatment to prevent the condition is missing, and lots of different strategies have been investigated. In this review, we aim to address the current options for treatment with the purpose to encourage focus on the topic and suggest strategies to prevent the condition in order to facilitate a better patient course.
Topics: Catheters, Indwelling; Humans; Urinary Bladder; Urinary Catheterization; Urinary Catheters
PubMed: 33998453
DOI: No ID Found -
Antimicrobial Resistance and Infection... 2014Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As... (Review)
Review
Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.
PubMed: 25075308
DOI: 10.1186/2047-2994-3-23 -
Translational Andrology and Urology Jul 2017As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage... (Review)
Review
As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity.
PubMed: 28791237
DOI: 10.21037/tau.2017.04.16 -
Urologia Internationalis 2021Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease... (Review)
Review
Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease activity. PM is the main pathogen causing complicated urinary tract infections (UTIs), especially catheter-associated urinary tract infections. Clinically, PM can form a crystalline biofilm on the outer surface and inner cavity of the urethral indwelling catheter owing to its ureolytic biomineralization. This leads to catheter encrustation and blockage and, in most cases, is accompanied by urine retention and ascending UTI, causing cystitis, pyelonephritis, and the development of bladder or kidney stones, or even fatal complications such as septicemia and endotoxic shock. In this review, we discuss how PM is mediated by a catheter into the urethra, bladder, and then rose to the kidney causing UTI and the main virulence factors associated with different stages of infection, including flagella, pili or adhesins, urease, hemolysin, metal intake, and immune escape, encompassing both historical perspectives and current advances.
Topics: Catheter-Related Infections; Humans; Proteus Infections; Proteus mirabilis; Urinary Catheters; Urinary Tract Infections
PubMed: 33691318
DOI: 10.1159/000514097 -
Acta Biomaterialia Mar 2017More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of... (Review)
Review
UNLABELLED
More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of hospitalized patients. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence. During catheter-associated urinary tract infections, bacteria travel up to the bladder and cause infection. A major cause of catheter-associated urinary tract infection is attributed to the use of non-ideal materials in the fabrication of urinary catheters. Such materials allow for the colonization of microorganisms, leading to bacteriuria and infection, depending on the severity of symptoms. The ideal urinary catheter is made out of materials that are biocompatible, antimicrobial, and antifouling. Although an abundance of research has been conducted over the last forty-five years on the subject, the ideal biomaterial, especially for long-term catheterization of more than a month, has yet to be developed. The aim of this review is to highlight the recent advances (over the past 10years) in developing antimicrobial materials for urinary catheters and to outline future requirements and prospects that guide catheter materials selection and design.
STATEMENT OF SIGNIFICANCE
This review article intends to provide an expansive insight into the various antimicrobial agents currently being researched for urinary catheter coatings. According to CDC, approximately 75% of urinary tract infections are caused by urinary catheters and 15-25% of hospitalized patients undergo catheterization. In addition to these alarming statistics, the increasing cost and health related complications associated with catheter associated UTIs make the research for antimicrobial urinary catheter coatings even more pertinent. This review provides a comprehensive summary of the history, the latest progress in development of the coatings and a brief conjecture on what the future entails for each of the antimicrobial agents discussed.
Topics: Animals; Anti-Bacterial Agents; Coated Materials, Biocompatible; Humans; Urinary Catheters; Urinary Incontinence; Urinary Tract Infections
PubMed: 27916738
DOI: 10.1016/j.actbio.2016.11.070 -
Frontiers in Medicine 2021Biofilms composed of multiple microorganisms colonize the surfaces of indwelling urethral catheters that are used serially by neurogenic bladder patients and cause...
Biofilms composed of multiple microorganisms colonize the surfaces of indwelling urethral catheters that are used serially by neurogenic bladder patients and cause chronic infections. Well-adapted pathogens in this niche are , and spp., species that cycle through adhesion and multilayered cell growth, trigger host immune responses, are starved off nutrients, and then disperse. Viable microbial foci retained in the urinary tract recolonize catheter surfaces. The molecular adaptations of bacteria in catheter biofilms (CBs) are not well-understood, promising new insights into this pathology based on host and microbial meta-omics analyses from clinical specimens. We examined catheters from nine neurogenic bladder patients longitudinally over up to 6 months. Taxonomic analyses from 16S rRNA gene sequencing and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics revealed that 95% of all catheter and corresponding urinary pellet (UP) samples contained bacteria. CB biomasses were dominated by spp. and often accompanied by lactic acid and anaerobic bacteria. Systemic antibiotic drug treatments of patients resulted in either transient or lasting microbial community perturbations. Neutrophil effector proteins were abundant not only in UP but also CB samples, indicating their penetration of biofilm surfaces. In the context of one patient who advanced to a kidney infection, proteomic data suggested a combination of factors associated with this disease complication: CB biomasses were high; the bacteria produced urease alkalinizing the pH and triggering urinary salt deposition on luminal catheter surfaces; utilized energy-producing respiratory systems more than in CBs from other patients. The NADH:quinone oxidoreductase II (Nqr), a Na translocating enzyme not operating as a proton pump, and the nitrate reductase A (Nar) equipped the pathogen with electron transport chains promoting growth under hypoxic conditions. Both and featured repertoires of transition metal ion acquisition systems in response to human host-mediated iron and zinc sequestration. We discovered a new drug target, the Nqr respiratory system, whose deactivation may compromise growth in a basic pH milieu. Animal models would not allow such molecular-level insights into polymicrobial biofilm metabolism and interactions because the complexity cannot be replicated.
PubMed: 34249966
DOI: 10.3389/fmed.2021.667462