Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis

Can We Prevent Recurrent UTIs Without Antibiotics, in Both Those Who Do and Do Not Use Catheters? ICI-RS 2024

AIMS

Urinary tract infections are one of the most common reasons for antibiotic prescription. The widespread use of antibiotic treatments contributes to the global health problem of antimicrobial resistance development. To slow down the progression of antimicrobial resistance, it is essential that we explore nonantibiotic preventive treatments for this common condition. We aim to report discussions regarding nonantibiotic preventive strategies for recurrent urinary tract infections in both catheterized and non-catheterized patients that took place at the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.

METHODS

We undertook a think-tank session during this multidisciplinary meeting specifically designated for discussion regarding both established and emerging nonantibiotic treatments for UTI prevention in both catheterized and non-catheterized patients. This led to the generation of pertinent research questions, which hope to shape future UTI research.

RESULTS

We describe the discussions that took place and document the important research questions that were proposed during the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.

CONCLUSIONS

There is a range of established UTI preventative strategies for UTI prevention in both catheterized and non-catheterized patients. Emerging UTI prevention treatments have varying levels of evidence to support their use, and in many areas, further research is needed to establish their place in clinical pathways.

Preventing catheter-associated urinary tract infections: A position paper of the International Society for Infectious Diseases, 2024 update

OBJECTIVES

This review, conducted by a panel of experts assembled by the International Society for Infectious Diseases, seeks to consolidate the latest recommendations for preventing catheter-associated urinary tract infections (CAUTIs). It offers insights into CAUTI rates and the associated extended hospital stays, costs, mortality, and risk factors across high- and low- to middle-income countries.

METHODS

An in-depth review of current recommendations and evidence-based strategies for CAUTI prevention was undertaken. To develop practical preventive measures, the expert panel examined data on CAUTI incidence, related health care impacts, and risk factors across various economic contexts.

RESULTS

The review highlights notable differences in CAUTI rates, health care costs, extended hospital stays, and mortality between high- and low- to middle-income countries. It emphasizes evidence-based strategies for CAUTI prevention, demonstrating their effectiveness across diverse health care environments.

CONCLUSIONS

This position paper offers recommendations and insights intended to assist health care professionals in effectively preventing CAUTIs. Implementing evidence-based preventive strategies has the potential to lower CAUTI rates, reduce related costs, and enhance patient outcomes in high- and low- to middle-income countries.

Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections: A Systematic Review and Meta-Analysis

BACKGROUND

Catheter-associated urinary tract infections (CAUTIs) are common health care-associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates.

PURPOSE

This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates.

METHODS

Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence.

RESULTS

Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation.

CONCLUSIONS

Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area.

Urinary Catheter-Associated Infections

Catheter-associated urinary tract infections (CAUTIs) are common and costly hospital-acquired infections, yet they are largely preventable. The greatest modifiable risk factor for developing a CAUTI is duration of catheterization, including initial indwelling catheter placement when it may not otherwise be necessary. Alternatives to indwelling urinary catheters, including intermittent straight catheterization and the use of external catheters, should be considered in applicable patients. If an indwelling urinary catheter is required, aseptic insertion technique and maintenance should be performed. Through the use of collaborative, multidisciplinary intervention efforts, CAUTI rates can be successfully reduced.

How to Prevent Catheter-Associated Urinary Tract Infections: A Reappraisal of Vico's Theory-Is History Repeating Itself?

New, contextualized modern solutions must be found to solve the dilemma of catheter-associated urinary infection (CAUTI) in long-term care settings. In this paper, we describe the etiology, risk factors, and complications of CAUTI, explore different preventive strategies proposed in literature from the past to the present, and offer new insights on therapeutic opportunities. A care bundle to prevent CAUTI mainly consists of multiple interventions to improve clinical indications, identifying a timeline for catheter removal, or whether any alternatives may be offered in elderly and frail patients suffering from chronic urinary retention and/or untreatable urinary incontinence. Among the various approaches used to prevent CAUTI, specific urinary catheter coatings according to their antifouling and/or biocidal properties have been widely investigated. Nonetheless, an ideal catheter offering holistic antimicrobial effectiveness is still far from being available. After pioneering research in favor of bladder irrigations or endovesical instillations was initially published more than 50 years ago, only recently has it been made clear that evidence supporting their use to treat symptomatic CAUTI and prevent complications is needed.