What is the most common urinary tract infection (UTI) bacteria associated with the use of an indwelling urinary catheter?

From the Guidelines

Catheter-associated urinary tract infections (CAUTIs) should be managed by replacing the catheter prior to antimicrobial treatment if it has been in place for at least 2 weeks, as this approach has been shown to decrease polymicrobic CA-bacteriuria and reduce the rate of CA-UTI within 28 days after therapy 1. When managing CAUTIs, it is essential to consider the potential for polymicrobial infections caused by multidrug-resistant uropathogens.

• The most common bacteria causing CAUTIs include Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus species, and Staphylococcus species.
• Empiric treatment typically involves antibiotics such as fluoroquinolones, with the specific choice depending on local resistance patterns and patient factors.
• Urine cultures should be obtained prior to treatment to confirm appropriate coverage and allow for tailoring of the regimen based on antimicrobial susceptibility data 1.
• In cases where the catheter has been in place for an extended period, replacement prior to treatment can improve clinical outcomes, including a shorter time to improved clinical status and a lower rate of CA-UTI recurrence 1.
• Prevention strategies for CAUTIs include using catheters only when necessary, maintaining a closed drainage system, ensuring proper aseptic technique during insertion, and removing catheters as soon as clinically appropriate.

From the Research

Mcc UtI Bacteria with Catheter

• The most common cause of urinary tract infections (UTIs) is Escherichia coli, which is implicated in 75-90% of cases in out-patient settings and 21-54% of urinary isolates in in-patient settings 2.
• Catheter-associated urinary tract infections (CAUTIs) account for almost half of all hospital-acquired diseases, and the length of catheterization plays a key role in the development of bacteriuria 3.
• The use of indwelling urinary catheters can lead to the formation of biofilm on the device, which can cause UTIs 3.
• Minimizing the use of indwelling devices and removing the catheter as soon as medically possible are crucial preventative measures for bacteriuria and infection 3.
• In patients with risk factors for antibiotic resistance, such as indwelling urinary catheter, the susceptibility of antimicrobials depends on these risk factors, and the choice of empiric therapy should be guided by local resistance rates and risk factors 4.
• Treatment options for UTIs caused by multidrug-resistant (MDR) organisms, including those with extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE), include fosfomycin, nitrofurantoin, fluoroquinolones, and carbapenems, among others 5, 6.

Risk Factors for Antibiotic Resistance

• Risk factors for antibiotic resistance in UTIs include residence in nursing homes, male gender, hospitalization within the last 30 days, renal transplantation, antibiotic treatment within the last 30 days, indwelling urinary catheter, and recurrent UTI 4.
• Patients with one or more risk factors have lower susceptibility to standard antimicrobial agents, such as ciprofloxacin, piperacillin-tazobactam, and gentamicin 4.

Prevention and Management of CAUTIs

• Efforts to prevent CAUTIs include minimizing the use of indwelling devices, monitoring device use, and implementing infection control guidelines in healthcare institutions 3.
• Technological advancements in device materials that inhibit colony formation may be necessary to prevent CAUTIs 3.
• Maintaining hygiene while handling the catheter and patients, and keeping infected patients isolated from unaffected patients, can help reduce the incidence of CAUTIs 3.