The AMR Narrative

Catheter-associated Urinary Tract Infection (CAUTI)

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What is a Catheter-associated Urinary Tract Infection (CAUTI)?

A Urinary Tract Infection (UTI) is an infection of the urinary tract, which includes different organs, such as the kidneys, ureters, bladder, and urethra. UTIs are the most common type of healthcare-associated infection and are often caused by the presence or placement of a catheter in the urinary tract.

A Catheter-associated Urinary Tract Infection (CAUTI) occurs when certain microorganisms (bacteria or fungi) enter the urinary tract through a catheter and cause an infection involving the bladder (cystitis) or even the kidneys (pyelonephritis), for example.

CAUTIs may be difficult to treat because of the increasing resistance of germs to the available antimicrobials. Therefore, CAUTIs are associated with increased mortality, healthcare costs, and length of hospital stay.

What is a urinary catheter?

A urinary catheter is a thin tube placed in the bladder to drain urine into a bag that collects the urine outside the body. This tube may stay in place for a long period of time. If so, it is called an indwelling catheter.

A urinary catheter may be used:

● if you are unable to urinate on your own;
● if you are very ill and cannot control your urine;
● during and right after some types of surgery;
● during some tests of the kidneys and bladder;
● to monitor the amount of urine during intensive care.
People with urinary catheters have a higher risk of developing a UTI than people who do not have a catheter. Moreover, the prolonged use of a urinary catheter is the most important risk factor for developing a CAUTI.

How do patients get a CAUTI?

Microorganisms, such as bacteria or fungi, may cause a CAUTI by entering the urinary tract. Indeed, germs can enter the bladder in several ways: during the insertion of the catheter, through the catheter lumen, or from around the outside of the catheter while the catheter remains in the bladder.
Many of the germs that cause CAUTIs are commonly found in the intestines, but do not usually cause an infection there.

What are the symptoms of a CAUTI?

Some common symptoms and signs of a CAUTI are the following:

● burning or pain in the lower abdomen;
● fever;
● bloody urine, or an abnormal urine colour;
● burning during urination or an increase in the frequency of urination after the catheter is removed.

Sometimes people with CAUTIs do not have these symptoms and signs of infection. Other symptoms that may occur with a CAUTI are chills, flank pain, mental changes or confusion.

How is a CAUTI diagnosed?

To correctly diagnose a CAUTI, first your physician will perform a physical examination and ask you about symptoms. Guided by these elements, your doctor will be able to choose the most appropriate diagnostic tests.

Laboratory tests used to identify a CAUTI are represented by urinalysis and urine culture. A sample of urine is sent to a laboratory to grow the microorganism over time using a media on a petri dish (culture) and identify it. Then susceptibility tests can be carried out to determine which antimicrobials are most effective against it, to start the most appropriate antimicrobial therapy. Understanding which antimicrobials will work best is especially key to CAUTIs as resistance among urinary pathogens is a constantly growing problem.

Finally, depending on the type of infection, your physician may recommend additional tests, such as imaging tests of the abdomen or pelvis.

How is a CAUTI treated?

Guided by the symptoms and the results of diagnostic tests, your physician will determine the best treatment for you. Antimicrobials, such as antibiotics or antifungals, may be used to treat a CAUTI.

The antimicrobials may vary according to the type of the infection, the microorganism responsible of the disease, and the results of susceptibility tests. Depending on the site and the severity of infection, the medications could be in the form of tablets to swallow. However, severe infections require to be treated in hospital with intravenous antimicrobials (the medications are given through a drip or a tube), and additional therapies. Finally, the urinary catheter may be removed or changed.

Unfortunately, due to the increasing resistance to the available antimicrobials, CAUTIs are becoming more and more difficult to treat, and sometimes a combination therapy is needed (it means that two or even more antimicrobials are necessary).

What can patients and caregivers do to help prevent a CAUTI?

Patients with a urinary catheter and their caregivers can take the following precautions to help to prevent a CAUTI.

● Understand why the urinary catheter has been placed.
● Ask frequently your doctor or nurse if you still need the urinary catheter. Indeed, the risk of CAUTI can be reduced by ensuring that catheters are used only when needed, and removed as soon as possible.
● Always clean your hands (by washing them with soap and water or using an alcohol-based hand rub) before and after touching the urinary catheter. Remember: hand hygiene is your best protection against infections.
● Always keep your urine bag below the level of your bladder to prevent urine from backflowing to the bladder.
● Do not tug or pull on the catheter tubing.
● Do not twist or kink the catheter tubing.
● If you suspect to have any symptoms of infection, call your doctor immediately.

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