Infection

Urinary tract infection (UTI) is the most common nosocomial infection, accounting for 40 percent of hospital-acquired infections. As many as 25 percent of patients admitted to academic hospitals have a catheter placed during their stay and, of these, between 10 and 30 percent will develop bacteriuria. Nearly all patients catheterized for longer than 30 days will develop a bacteriuria. 1

The bacteriuria appears to be as a result of direct inoculation along the inner and outer surfaces of the catheter. Women tend to be infected via the periurethral route, with approximately 70 percent of UTIs being caused by rectal flora, whereas the majority of UTIs in men occur through the intraluminal route. Prevention of bacteriuria in the setting of indwelling catheterization is best accomplished through routine cleaning of the urethral meatus and use of closed drainage systems.

A large number of patients are catheterized while hospitalized, and a portion of those will develop a UTI after discharge and may return to the emergency department with symptoms. The most common pathogens associated with short-term catheter-related UTIs are well known (Table.. ..9.5.-1). Although more than 70 percent of patients will clear a bacteriuria after catheter removal, symptomatic patients should receive antimicrobial treatment.

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