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Catheter Associated Urinary Tract Infection

Djoko Rahardjo
• UTI is a common cause hospital-
acquired infection
• Mostly due to catheters
• Up to 25% of inpatients are catheterized
• Leads to increased morbidity and
healthcare costs
UTI – Definitions (1)

National Health Service (NHS) and National Surgical Quality

Improvement Program (NSQIP)
UTI – Definitions (2)

National Health Service (NHS) and National Surgical Quality

Improvement Program (NSQIP)
Introduction - Catheter
• Catheter is the most common indwelling device in hospitals
– Short term  in situ for < 30 days period
– Chronic / long term  in situ ≥ 30 days

Caude Silicone
2-way catheter 3-way catheter CiC
catheter catheter
Small tube – big problem
There is growing evidence that urinary catheters
are over-used and that many could be avoided

1in 5 people
staying in
hospital will have
an indwelling
When to use and not to use
Indication Contraindication
Main categories: • Signs of urethral Trauma (perform
1. To obtain drainage genital and rectal examination at first)
2. To allow the instillation of diagnostic or – Blood at meatus
therapeutic agents. – Scrotal hematoma
Another indications:
 Urethrography
1. To monitor urinary output
2. Allow healing after lower urinary tract  Cystostomy (if urinary retention
surgery/trauma persist)
3. The removal of clots debris
4. Collection of microbiologic clean urine
5. Measure post-void residual urine volume for
diagnostic purposes
Mendez-Probst, Razvi, Denstedt. Campbell-Walsh Urology 2012
Catheter Selection
Number of
Size Material

5-8 Fr Single
• Depends on: (<5 y.o) lumen

– Indication for 8-10 Fr

Rubber 2-way
catheter insertion (5-10 y.o)
– Age of patient 10-14 Fr
Silicone 3-way
– Type of fluid (10-14 y.o)
expected to be 16-20 Fr
drained (adult)
Less bacterial
adherence and less
tissue reaction for
longer use
24 Fr (Crnich, et al, 2007)
(post TUR)
Definitions –
Catheter Associated UTI

UTI that occurs while a patient

has an indwelling urinary catheter
or within 48 hours of its removal
Magnitude of CAUTI
• The most prevalent hospital acquired infection
• 40% of all hospital acquired infections are CAUTIs
• The highest rates: burn ICUs, inpatient medical wards, neurosurgical
– 25% chance after 1-week catheter use
– 50% chance after 2-week catheter use
• Estimated cost of each episode:
– U.S: 2800 $
– U.K: 2500 £
• CAUTIs cause 13,000 deaths (mortality rate 2.3%) in the US each year
• Mean incidence rate: 3.1-7.5 infections per 1000 catheter days (CDC)
vs. 0.09 per 1000 catheter days (RSCM-PPIRS, 2017)
Pathogenesis - Biofilm
Risk Factors
Microorganisms Antibiotics
General UTI • Amoxicillin -
RSCM - 2017 Clavulanic Acid
• Ciprofloxacin
• Levofloxacin
• Cefoperazone
• Cefotaxime
• Ceftriaxone
• Gentamicin
• Amikacin
• Meropenem
Disrupting the lifecycle
of urinary catheter
1. Potential site of infection
and Improper

3. Maintaining
Prompting Awareness &
Catheter Proper Care
Removal of Catheters
Proper Technique of insertion
 CAUTI prevention
The equipments:
– Sterile gloves
– Sterile drapes
– Cleansing solution
– Cotton swabs
– Forceps
– Sterile water (usually 10cc)
– Foley Catheter
– Syringe
– Lubricant
– Collection bag and tubing
Female Catheterization Steps
1. Positioning & visualization of urethral meatus.
2. Swab clean the urethral meatus, Lubricate the
catheter tip with sterile jelly.
3. Hold the catheter in the dominant hand,
introduce the catheter tip into the meatus, and
gently push catheter inside the urethra.
4. If you insert catheter into the vagina, start again
with a new sterile catheter.
5. Female urethra is short. Once you see urine
flowing, push the catheter 3 to 5 cm further, then
inflate the balloon.
Male Catheterization Steps
1. Exposure of glans penis and hold the penile shaft
perpendicular with non-dominant hand
2. Swab clean the urethral meatus and glans, apply
lidocaine jelly inside the urethra
3. Lubricate the catheter tip, gently Insert into
urethra with dominant hand.
4. If resistance is met ask the patient to relax, or use
coude tip catheter in enlarged prostates.
5. Never inflate the balloon until urine has been
visualized and is draining.
6. If the foreskin is retracted in uncircumcised
patients, return it to prevent paraphimosis.
Prevention is always important…
Management of CAUTI
• Do not treat asymptomatic bacteriuria
• Empiric broad spectrum  for severe symptoms and high
• Mild symptoms  await culture
• Change to narrowest possible spectrum when sensitivities
• 5-7 days of antibiotics (14 days for chronically catheterized
Peterson et al. Urology 2008;71(1): 17-22
Thank You