Catheter Associated Urinary Tract Infection

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Indwelling urinary catheters are usually used in hospitals to help people who, due to their health problems are not able to urinate by themselves. Urinary tract infection is a common complication (Niël-Weise BS, van den Broek PJ. Cochrane Database of Systematic Reviews 2005, Issue 3).  Most CAUTI (Catheter associated Urinary Tract infection) are caused by the samples of own intestinal microflora of the patient. One of the major hazards is Catheter-related bacteriuria that occurs while the catheter is implied, thus daily 5% of patients are colonized.

The clinician should be aware of the two most important points:

- Drainage system should remain closed;

- The time of catheterization should be minimal.

There is no need for a systemic antimicrobial therapy of asymptomatic Catheter-related bacteriuria while a catheter is applicable.

However, there are some exceptions:

(?) patients with the risk of disease progression to severe infectious complications;

(b) patients undergoing urological operations;

(?) implantation of prosthetic devices;

(d) patients infected with strains of pathogens that commonly cause bacteremia ;

(?) specific symptomatic infection (eg, pyelonephritis, epididymitis);

(f) nonspecific illness with fever,  presumably due to bacteremia caused by uropathogens,  after excluding other causes of infection.

Urethral catheter may inhibit or "bypass" some protective mechanisms (for example, layer of glycosaminoglycans on the surface epithelium of the urethra), that normally prevent or minimize the interaction of bacterial cells with the epithelium and the formation of biofilms.  In catheterized patients, the bacteria can enter the urinary tract in the following ways:

  1. During the catheter insertion (in case of inadequate treatment of catheter site, the external opening of the urethra and perineum).
  2. After the catheter  is inserted

Prolonged catheterization contributes to the formation of mucous clutch freely disposed off the wall between the catheter and the urethral mucosa.  This coupling creates a favorable environment for the invasion and penetration of bacteria. This is the reason for the increased frequency of bacteriuria in women (70-80%) than men (20-30%).

There are several types of catheterization: one-time catheterization, short-term catheterization, and long-term catheterization. In one-time catheterization,   bacteriuria occurs in 1-5% of patients. Short-term catheterization may be performed in the intensive care unit for patients with disturbed random urination or incontinence. Between 15% and 25% of patients admitted to hospital may be catheterized between 2 and 4 days of hospitalization. In 10-30% of them the bacteriuria will develop. Long-term catheterization may increase the duration of obstruction of lower urinary tract due to the catheter’s obstruction, formation of urinary stones, the development of epididymitis, prostatitis, and scrotal abscess. Nevertheless, more than 30% of deaths in patients with long-term catheters, which at the time of his death was no fever, the autopsy showed signs of acute pyelonephritis.

The physicians use several methods of catheterizations: the indwelling urethral catheterization, the suprapubic catheterization, and the intermittent catheterization.

The studies with multivariate analysis showed that the duration of catheterization is the most important risk factor for Catheter- related bacteriuria. The time needed for catheterization is determined by the indication for its conduct. Among them are:

(?) elective surgery on the abdominal cavity (from 1 to 7 days)

 (b) amount of urine outcome during intensive therapy (7-30 days)

(?) acute and chronic urinary retention (from 1 to 30 days)

(d) incontinence ( 30 days).

Longtime bladder catheterization increases the risk of bladder cancer.

The research showed that to provide a patient properly with a bladder catheter, one should take into account many characteristics, such as patient’s condition, the term of the catheterization, possible complications etc. After considering all these factors, it is necessary to choose the right method of catheterizing.

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