Introduction:
Catheter-associated urinary tract infection (CAUTI) is an infection that is caused when a catheter is inserted into the urinary bladder. This will provide a pathway for the bacteria to spread an infection. CAUTI is the most commonly seen healthcare-associated infection. Urinary catheters are used in the management of urinary retention, to assist surgical procedures, or to monitor urine output. Inappropriate or prolonged use of urinary catheters can result in a high risk of infection. As the duration of the catheter remaining in place is high, the chance of getting bacteria colonizing the device is also high.
What Are the Causes of Catheter-Associated Urinary Tract Infections?
The catheter-associated urinary tract infection is caused by the spread of bacteria into the urinary tract through the urinary catheters. There are several factors that will result in the development of the CAUTI, including:
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Bacterial Colonization - During the insertion of a urinary catheter, there will be a direct pathway for the bacteria to enter the urinary tract. The bacteria can be originated from the gastrointestinal tract or the patient's skin. It can be introduced during the insertion of catheter maintenance or during drainage system manipulation.
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Biofilm Formation - Biofilms are a layer of bacteria that is attached to the surface of the catheter, which forms a protective barrier. The biofilm helps the bacteria evade the body's natural defense mechanism and makes it more resistant to antibiotics.
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Prolonged Catheterization - As the duration of a catheter inserted into the urinary bladder increases, there is an increased chance of developing catheter-associated urinary tract infection. Prolonging the catheterization will increase the risk of the bacteria colonizing the urinary tract.
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Catheter Insertion Technique - Improper insertion technique of the catheter, like non-sterile conditions or inadequate hand hygiene, can result in the spread of bacteria into the urinary tract. Therefore it is essential to follow an aseptic technique during the insertion of the catheter in order to minimize the risk of infection.
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Catheter Maintenance and Care - Inadequate care of the catheter and poor maintenance can increase the risk of catheter-associated urinary tract infection. This can include improper handling and emptying drainage bag, failure to keep the drainage bag and catheter sterile, and inadequate periurethral hygiene.
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Compromised Immune System - Individuals with weak immune systems, like diabetes, immunosuppressed patients, or elderly people, are more susceptible to infections, including catheter-associated urinary tract infections.
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Underlying Medical Condition - Certain underlying medical conditions like neurogenic bladder dysfunction or urinary tract obstruction can result in long-term catheterization, which will increase the risk of causing catheter-associated urinary tract infections.
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Contamination During Drainage System Manipulation - Manipulation of the drainage system or catheter, like reconnecting or disconnecting the tubes, can sometimes introduce bacteria into the urinary tract if not done with aseptic measures.
What Are the Symptoms of Catheter-Associated Urinary Tract Infections?
Some of the common symptoms of catheter-associated urinary tract infection include the following:
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There will be an increased urge to pass the urine, and the frequency of passing the urine will also be high.
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The patients can experience burning sensations, pain, and discomfort while passing urine (dysuria).
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The urine can appear dark and cloudy with an unpleasant odor.
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Sometimes there can be a presence of blood seen in the urine called hematuria, which appears as red, pink, or cola-colored urine.
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It can cause difficulty while emptying the bladder, which will lead to the presence of residual bladder in the bladder.
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There can be a presence of pain or discomfort in the pelvic region or lower abdomen.
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Fever, fatigue, chills, and malaise can be seen in CAUTI.
What Are the Complications of Catheter-Associated Urinary Tract Infections?
Some of the complications of CAUTI include:
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Catheter-associated urinary tract infections can result in a kidney infection called pyelonephritis. It is caused when the bacteria goes to the kidneys from the bladder, which result in infection and inflammation. It can result in nausea, high fever, and vomiting and require hospitalization.
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If the bacteria causing the catheter-associated urinary tract infection enter the bloodstream (bacteremia), it can result in sepsis which is a life-threatening condition to the infection which will cause inflammation in the body. It is associated with symptoms like rapid heartbeat, confusion, fever, rapid breathing, and decreased urine output.
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When the bacteria from the urinary tract infection spreads to the bloodstream, sometimes it can result in a systemic infection called urosepsis.
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It can cause chronic kidney infection and damage.
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Prolonged CAUTI can result in narrowing and scarring of the urethra, called ureteral stricture.
What Are the Prevention Strategies for Catheter-Associated Urinary Tract Infections?
Some of the strategies used in the prevention of catheter-associated urinary tract infections include the following:
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Use the urinary catheters only when necessary.
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Ensure to use the proper catheter insertion technique and follow strict sterilization and aseptic techniques during the insertion and removal.
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Proper maintenance protocol of the catheter should be implemented, like regular cleaning of the periurethral area and catheter.
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The catheters should be securely fastened or taped in order to prevent accidental dislodgement and movement.
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Regular review of the catheterization should be done.
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Proper positioning and securing the urinary drainage back help prevent the backflow of urine. The drainage bags should not be placed on the floor in order to prevent contamination.
How Is Catheter-Associated Urinary Tract Infection Diagnosed?
The diagnosis of catheter-associated urinary tract infection is by:
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Clinical assessment of the symptoms like frequency and urgency of the urination, painful urination, foul smelling urine, and some systemic infection signs like elevated heart rate or fever.
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A urine sample should be collected and will be analyzed for the presence of infection and bacteria.
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A urine culture is performed by incubating the urine sample, which helps in identifying the specific bacteria that causes the infection.
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In some cases, the catheter tip itself is cultured to help identify the bacteria colonized.
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Blood cultures are taken to identify the bacteria present in the bloodstream.
How Is Catheter-Associated Urinary Tract Infection Treated?
The treatment of catheter-associated urinary tract infection includes the following:
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Antimicrobial therapy.
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Management of the catheter.
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Supportive care.
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Follow-up and monitoring.
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Addressing underlying conditions.
Conclusion:
In conclusion, catheter-associated urinary tract infection is a commonly seen healthcare-associated infection that is preventable. During the insertion and usage of a urinary catheter, there will be a direct pathway for the bacteria to spread in the urinary tract, which can result in an infection. CAUTI can be prevented by a comprehensive approach like proper insertion technique of catheter, adherence to the infection control practice, regular assessment of the need for catheterization, etc.
