What is the recommended prophylactic treatment for catheter-associated urinary tract infections (UTIs)?

Prophylactic Treatment of Catheter-Associated UTI

Prophylactic antimicrobials should not be administered routinely to patients at the time of catheter placement, removal, or replacement to reduce catheter-associated urinary tract infections (CA-UTIs). 1

Prevention Strategies

• The most effective methods to prevent CA-UTIs are avoiding unnecessary catheterizations and removing catheters as soon as medically possible 2
• Implementation of reminder systems and infection control programs can effectively decrease CA-UTI rates, though their introduction can be challenging 2
• Routine screening for and treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) is not recommended for patients with short-term or long-term indwelling urethral catheters 1
• Prophylactic antimicrobials should not be administered at the time of:
  • Catheter placement (Grade A-I recommendation) 1
  • Catheter removal (Grade B-I recommendation) 1
  • Catheter replacement (Grade A-III recommendation) 1

Special Circumstances

• Antimicrobial treatment of CA-ASB that persists 48 hours after short-term indwelling catheter removal in women may be considered to reduce subsequent CA-UTI risk (Grade C-I recommendation) 1
• Prophylactic antimicrobials may be warranted in specific high-risk situations:
  • Pregnant women with CA-ASB (Grade A-III recommendation) 1
  • Patients undergoing urologic procedures where visible mucosal bleeding is anticipated (Grade A-III recommendation) 1

Catheter Management

• If an indwelling catheter has been in place for ≥2 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced before starting antimicrobial therapy 1, 3
• This practice has been shown to:
  • Decrease polymicrobial CA-bacteriuria 1
  • Shorten time to clinical improvement 1
  • Lower rates of CA-UTI recurrence within 28 days after therapy 1
• There is insufficient evidence to recommend routine periodic catheter changes (e.g., every 2-4 weeks) in patients with long-term indwelling catheters to prevent CA-ASB or CA-UTI 1

Pitfalls to Avoid

• Administering prophylactic antimicrobials routinely at catheter placement/removal can promote antimicrobial resistance 1
• Studies have shown that prophylactic antimicrobial use in long-term catheterized patients leads to reinfection with more resistant organisms (47% vs 26% in control groups) 1
• Treating asymptomatic bacteriuria in catheterized patients (except in specific circumstances) does not reduce subsequent CA-UTI and may increase antimicrobial resistance 1
• Failing to obtain cultures before initiating antimicrobials for symptomatic CA-UTI may lead to inappropriate antibiotic selection given the high likelihood of resistant organisms 3, 4

Emerging Technologies

• While antimicrobial-impregnated catheters have been proposed as prevention methods, there is insufficient evidence to support their routine use 2, 5
• Hydrophilic-coated catheters for clean intermittent catheterization have shown effectiveness in reducing infections 2
• Preliminary results with chlorhexidine-coated catheters show promise but require further evaluation 2
• Novel approaches under development include new catheter coatings/materials, vaccination strategies, and bacterial interference techniques 4