🦠 Catheter-Associated Urinary Tract Infection [Neurosurgery Wiki]

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====== 🦠 Catheter-Associated Urinary Tract Infection ======

[[Catheter]]-associated [[urinary tract infection]] (CAUTI) is one of the most common healthcare-associated infections, especially in hospitalized and catheterized patients.

===== 📌 Definition =====
Infection of the urinary tract occurring in a patient who has had an indwelling urinary catheter in place for more than 2 days **or within 48 hours of catheter removal**, without another identifiable source of infection.

===== 📊 Epidemiology =====

[[Catheter-Associated Urinary Tract Infection Epidemiology]]

===== 🔍 Pathophysiology =====
  * **Intraluminal route**: entry via contaminated collection system.
  * **Extraluminal route**: migration of organisms along the external surface.
  * Biofilm formation on catheter surfaces contributes to persistence and antibiotic resistance.

===== 🧫 Common Pathogens =====
  * **Gram-negative**: ''E. coli'', ''Klebsiella spp.'', ''Proteus spp.'', ''Pseudomonas spp.''
  * **Gram-positive**: ''Enterococcus spp.'', ''Staphylococcus aureus''
  * **Fungi**: ''Candida spp.'' (especially in patients with prolonged antibiotic use)

===== ⚠️ Clinical Features =====
  * Often **asymptomatic**, especially in chronically catheterized individuals.
  * When symptomatic:
    * Fever
    * Suprapubic or flank pain
    * Hematuria
    * Mental status changes (elderly)
    * Sepsis or systemic signs

===== 🧪 Diagnosis =====
  * Urine culture from catheter or freshly placed catheter: **>10^5 CFU/mL**
  * Must correlate with **clinical signs/symptoms**.
  * Do **not screen or treat asymptomatic bacteriuria**, except in specific cases (e.g., prior to urologic surgery).

===== 💊 Treatment =====
  * **Targeted antibiotic therapy** based on culture results.
  * Duration:
    * **5–7 days**: mild/moderate cases with good response.
    * **10–14 days**: severe infection, bacteremia, or persistent symptoms.
  * **Catheter removal or exchange** is essential.

===== 🛡️ Prevention =====
  * Avoid unnecessary catheterization.
  * Use sterile technique for insertion.
  * Maintain closed drainage system.
  * Daily reassessment of catheter need.
  * Use **external catheters** or **intermittent catheterization** when possible.
  * Consider **antimicrobial-impregnated catheters** in high-risk patients.