Complications of urinary tract infections associated with devices used for long-term bladder management

doi:10.1016/0195-6701(94)90101-5

Journal of Hospital Infection

Volume 28, Issue 3, November 1994, Pages 177-194

https://doi.org/10.1016/0195-6701(94)90101-5 Get rights and content

Abstract

The long-term indwelling urethral catheter continues to be a major cause of morbidity in patients in hospitals, nursing homes and home care. Many authorities have recommended that wherever possible, alternative techniques should be considered for the management of patients with urinary retention or incontinence. This article considers the complications that develop from the urinary tract infections associated with long-term indwelling catheterization and reviews the evidence that the other options for bladder management pose less serious threats to health.

References (119)

P Beeson
The case against the catheter
Am J Med
(1958)
OB Jepsen et al.
Urinary tract infection and bacteraemia in hospitalized medical patients—a European multicentre prevalance survey on nosocomial infection
J Hosp Infect
(1982)
P Nordqvist et al.
Catheter-free geriatric care. Routines and consequences for clinical infection, care and economy
J Hosp Infect
(1984)
J Zimakoff et al.
Management of urinary bladder function in Danish hospitals, nursing homes and home care
J Hosp Infect
(1993)
AB Mulhall et al.
Bacteriuria during indwelling urethral catheterization
J Hosp Infect
(1988)
RW Haley et al.
Nosocomial infections in US hospitals, 1975–1976: Estimated frequency by selected characteristics of patients
Am J Med
(1981)
PD Meers et al.
National survey of infection in hospitals 1980. Part 2: Urinary tract infection
J Hosp Infect
(1981)
D Gordon et al.
Diagnostic criteria and natural history of catheterassociated urinary tract infections after prostatectomy
Lancet
(1983)
CL Clayton et al.
Some observations on urinary tract infections in patients undergoing long-term bladder catheterization
J Hosp Infect
(1982)
M Ohkawa et al.
Bacterial and crystal adherence to the surfaces of indwelling urethral catheters
J Urol
(1990)

DJ Stickler et al.

The resistance of urinary tract pathogens to chlorhexidine bladder washouts

J Hosp Infect

(1987)

JG Ouslander et al.

Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study

J Urol

(1987)

JW Warren et al.

Sequelae and management of urinary infection in the patient requiring chronic catheterization

J Urol

(1981)

JM Kaufman et al.

Bladder cancer and squamous metaplasia in spinal cord injury patients

J Urol

(1977)

BH Broecker et al.

Cancer of the bladder in spinal cord injury patients

J Urol

(1981)

JR Locke et al.

Incidence of squamous cell carcinoma in patients with long-term catheter drainage

J Urol

(1985)

DE Bejany et al.

Malignant vesical tumors following spinal cord injury

J Urol

(1987)

M Yaqoob et al.

Bladder tumours in paraplegic patients on renal replacement therapy

Lancet

(1991)

H Akaza et al.

Bladder cancer induced by noncarcinogenic substances

J Urol

(1984)

AF Badawi et al.

Involvement of alkylating agents in schistosome-associated bladder cancer: the possible basic mechanisms of induction

Cancer Lett

(1992)

SL Stover et al.

Neurogenic urinary tract infection

Neurologic Clinics

(1991)

CM Kunin et al.

Formation of encrustations on indwelling catheters in the elderly: a comparison of different types of catheter materials in “blockers” and “nonblockers”

J Urol

(1987)

CM Kunin

Blockage of urinary catheters: role of microorganisms and constituents of the urine on formation of encrustations

J Clin Epidemiol

(1989)

AJ Cox et al.

Morphology of mineral deposits on encrusted urinary catheters investigated by scanning electron microscopy

J Urol

(1989)

DWL Hukins et al.

Calcium environment in encrusting deposits from urinary catheters investigated by interpretation of EXAFS spectra

J Inorg Biochem

(1989)

I Perkash

Intermittent catheterization and bladder rehabilitation in spinal cord injury patients

J Urol

(1975)

J Lapides et al.

Clean intermittent self-catheterization in the treatment of urinary tract disease

J Urol

(1972)

EJ McGuire et al.

Long-term followup of spinal cord injury patients managed by intermittent catheterization

J Urol

(1983)

JJ Wyndaele et al.

Clean intermittent self-catheterization: a 12-year follow-up

J Urol

(1990)

DC Lin-Dyken et al.

Follow-up of clean intermittent catheterization for children with neurogenic bladders

Urology

(1992)

A Bakke et al.

Risk factors for bacteriuria and clinical urinary tract infection in patients treated with clean intermittent catheterization

J Urol

(1993)

D Rudman et al.

Clinical correlates of bacteraemia in a Veterans Administration extended care facility

J Am Geriatr Soc

(1988)

JR Hebel et al.

The use of urethral, condom and suprapubic catheters in aged nursing home patients

J Am Geriatr Soc

(1990)

LG Burman et al.

Use of indwelling urinary tract catheters in Swedish hospitals

Infect Control

(1987)

HJM Cools et al.

Restriction of long-term indwelling urethral catheterisation in the elderly

Br J Urol

(1986)

JW Warren et al.

The prevalence of urethral catheterization in Maryland nursing homes

Arch Intern Med

(1989)

KA Getliffe et al.

The encrustation of indwelling catheters

Br J Urol

(1991)

RA Garibaldi et al.

Factors predisposing to bacteriuria during indwelling urethral catheterization

N Eng J Med

(1974)

RW Haley et al.

The nationwide nosocomial infection rate

Am J Epidemiol

(1985)

AI Hartstein et al.

Nosocomial urinary tract infection: A prospective evaluation of 108 catheterized patients

Infect Control

(1981)

RA Garibaldi et al.

An evaluation of bacteriological daily monitoring to identify preventable episodes of catheter associated urinary tract infection

Infect Control

(1982)

JN Krieger et al.

Urinary tract etiology of bloodstream infections in hospitalized patients

J Infect Dis

(1983)

CS Bryan et al.

Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome

J Urol

(1984)

JW Warren et al.

A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters

J Infect Dis

(1982)

JC Nickel

Catheter-associated urinary tract infection: New perspectives on old problems

Can J Infect Control

(1991)

JC Nickel et al.

Electron microscopic study of an infected Foley catheter

Can J Surg

(1985)

JWA Ramsay et al.

Biofilms, bacteria and bladder catheters

Br J Urol

(1989)

L Ganderton et al.

Scanning electron microscopy of bacterial biofilms on indwelling bladder catheters

Eur J Clin Microbiol Infect Dis

(1992)

ET Jensen et al.

Human polymorphonuclear leukocyte response to Pseudomonas aeruginosa grown in biofilms

Infect Immun

(1990)

JC Nickel et al.

Tobramycin resistance of Pseudomonas aeruginosa cells growing as a biofilm on urinary catheter material

Antimicrob Agents Chemother

(1985)

Cited by (92)

Urinary tract infections caused by Proteus mirabilis
2023, Molecular Medical Microbiology, Third Edition
Urinary tract infections (UTIs) caused by Proteus mirabilis occur primarily in those individuals with abnormal urinary tracts or using indwelling catheters. Since most research that has been done on non-Escherichia coli uropathogens has been conducted on P. mirabilis, this organism serves as a model of pathogenesis for these types of infections. To establish and infect the urinary tract, P. mirabilis must possess virulence factors to adapt to the local environment and evade the host immune response. The virulence factors involved in UTIs caused by P. mirabilis include adhesins, motility, biofilm formation, immunoavoidance, toxins, and nutrient acquisition. The annotation of the P. mirabilis genome and transcriptome profiling has allowed for the better understanding of the disease process caused by P. mirabilis in the urinary tract. This chapter reiterates previous works from the second edition and introduces current research being performed on this uropathogen including vaccine development and antibiotic resistance.
An in-situ infection detection sensor coating for urinary catheters
2016, Biosensors and Bioelectronics
Citation Excerpt :
In the US alone, ~30 million urinary catheters are fitted each year, making IUCs by far the most commonly deployed medical device, with levels of use far outstripping other common devices such as central venous catheters or fracture fixation devices (Darouiche, 2001). Although in many cases the use of IUCs can benefit patients and greatly aid treatment and recovery, these devices undermine the innate barriers to bacterial colonisation naturally present in the urinary tract, thus predisposing patients to infection by uropathogenic bacteria (Stickler and Zimakoff, 1994; Stickler, 2014). Given the widespread use of these devices, it is perhaps unsurprising that catheter associated urinary tract infections (CAUTIs) are currently among the most common nosocomial infections in many healthcare settings (Stickler, 2014; Jacobsen et al., 2008; Tambyah, 2004; Hooton et al., 2010; Getliffe and Newton, 2006).
We describe a novel infection-responsive coating for urinary catheters that provides a clear visual early warning of Proteus mirabilis infection and subsequent blockage. The crystalline biofilms of P. mirabilis can cause serious complications for patients undergoing long-term bladder catheterisation. Healthy urine is around pH 6, bacterial urease increases urine pH leading to the precipitation of calcium and magnesium deposits from the urine, resulting in dense crystalline biofilms on the catheter surface that blocks urine flow. The coating is a dual layered system in which the lower poly(vinyl alcohol) layer contains the self-quenching dye carboxyfluorescein. This is capped by an upper layer of the pH responsive polymer poly(methyl methacrylate-co-methacrylic acid) (Eudragit S100®). Elevation of urinary pH (>pH 7) dissolves the Eudragit layer, releasing the dye to provide a clear visual warning of impending blockage. Evaluation of prototype coatings using a clinically relevant in vitro bladder model system demonstrated that coatings provide up to 12 h advanced warning of blockage, and are stable both in the absence of infection, and in the presence of species that do not cause catheter blockage. At the present time, there are no effective methods to control these infections or provide warning of impending catheter blockage.
Preventing Infection Associated with Urethral Catheter Biofilms
2014, Biofilms in Infection Prevention and Control: A Healthcare Handbook
Approximately 70 to 80% of healthcare-acquired infections (HCAI) are attributed to use of an indwelling urethral catheter. The term ‘catheter-acquired urinary tract infection’ (CA-UTI) refers to symptomatic UTI occurring in an individual with a current or recently removed indwelling urethral catheter. Development of bacteriuria correlates with the duration of catheterisation and is primarily attributable to biofilm formation on the catheter. Numerous organisms are associated with CA-UTI, with the urease-producing organisms, particularly Proteus mirabilis, of unique importance.
Urease hydrolyses urea resulting in an increase in the pH of urine, which causes magnesium and calcium phosphate crystals to be precipitated and aggregates of this crystalline material then accumulate in the urine and the biofilm on the catheter surface, leading to catheter blockage in patients with long-term indwelling catheters. If the blockage is not detected early, then complications, such as incontinence, retention of urine in the bladder, reflux of infected urine, pyelonephritis and septicaemia, can arise. Prevention of CA-UTI includes avoidance of catheter use, correct catheter insertion and maintenance and efficient use of programs to monitor catheter use and duration.
Urinary Tract Infections Caused by Proteus mirabilis
2014, Molecular Medical Microbiology
Urinary tract infections (UTIs) are common nosocomial infections. Proteus mirabilis is a frequent cause of these infections in individuals with abnormal urinary tracts or using indwelling catheters (CAUTIs). Since most research on non-E. coli uropathogens has been conducted on P. mirabilis, this organism serves a model of pathogenesis for these types of infections. To establish and infect the urinary tract, P. mirabilis must possess virulence factors to adapt to the local environment and to evade the host immune response. The virulence factors known to be involved in UTIs caused by P. mirabilis include adhesins, motility, biofilm formation, immunoavoidance, toxins and nutrient acquisition. The annotation of the P. mirabilis genome and transcriptome profiling have allowed for better understanding of the disease process caused by this bacteria in the urinary tract. This chapter reiterates previous works discussed in the first edition and introduce current research being performed on this uropathogen.
Infection responsive coatings to reduce biofilm formation and encrustation of urinary catheters
2023, Journal of Applied Microbiology
Catechol-modified chitosan hydrogel containing PLGA microspheres loaded with triclosan and chlorhexidine: a sustained-release antibacterial system for urinary catheters
2022, Pharmaceutical Development and Technology

View all citing articles on Scopus

View full text

Review articleComplications of urinary tract infections associated with devices used for long-term bladder management

Abstract

Am J Med

J Hosp Infect

J Hosp Infect

J Hosp Infect

J Hosp Infect

Am J Med

J Hosp Infect

Lancet

J Hosp Infect

J Urol

J Hosp Infect

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

Lancet

J Urol

Cancer Lett

Neurologic Clinics

J Urol

J Clin Epidemiol

J Urol

J Inorg Biochem

J Urol

J Urol

J Urol

J Urol

Urology

J Urol

Clinical correlates of bacteraemia in a Veterans Administration extended care facility

J Am Geriatr Soc

The use of urethral, condom and suprapubic catheters in aged nursing home patients

J Am Geriatr Soc

Use of indwelling urinary tract catheters in Swedish hospitals

Infect Control

Restriction of long-term indwelling urethral catheterisation in the elderly

Br J Urol

The prevalence of urethral catheterization in Maryland nursing homes

Arch Intern Med

The encrustation of indwelling catheters

Br J Urol

Factors predisposing to bacteriuria during indwelling urethral catheterization

N Eng J Med

The nationwide nosocomial infection rate

Am J Epidemiol

Nosocomial urinary tract infection: A prospective evaluation of 108 catheterized patients

Infect Control

An evaluation of bacteriological daily monitoring to identify preventable episodes of catheter associated urinary tract infection

Infect Control

Urinary tract etiology of bloodstream infections in hospitalized patients

J Infect Dis

Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome

J Urol

A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters

J Infect Dis

Catheter-associated urinary tract infection: New perspectives on old problems

Can J Infect Control

Electron microscopic study of an infected Foley catheter

Can J Surg

Biofilms, bacteria and bladder catheters

Br J Urol

Scanning electron microscopy of bacterial biofilms on indwelling bladder catheters

Eur J Clin Microbiol Infect Dis

Human polymorphonuclear leukocyte response to Pseudomonas aeruginosa grown in biofilms

Infect Immun

Tobramycin resistance of Pseudomonas aeruginosa cells growing as a biofilm on urinary catheter material

Antimicrob Agents Chemother

Review article
Complications of urinary tract infections associated with devices used for long-term bladder management