Millions of
urethral catheters are used each year. This device subverts several host defenses to allow bacterial entry at the rate of 3% to 10% incidence per day, and its presence encourages the organism's persistent residence in the urinary tract. Most
catheter-associated
bacteriurias are asymptomatic. The complications in short-term catheterized patients include
fever, acute
pyelonephritis,
bacteremia, and death; patients with long-term
catheters in place are at risk for these complications and catheter obstruction,
urinary tract stones, local periurinary
infections, chronic renal
inflammation, chronic
pyelonephritis, and, over years,
bladder cancer. The closed
catheter system has been a magnificant step forward in the prevention of
catheter-associated
bacteriuria. Indeed, only two
catheter principles are universally recommended: keep the closed
catheter system closed and remove the
catheter as soon as possible. Most modifications of the closed
catheter system have not improved markedly on its ability to postpone
bacteriuria. On first inspection, systemic
antibiotics seem to be an exception to this rule, but their use results in
infection of the bladder with resistant organisms, including candida. This and the effect of side effects on the patient and emergence of resistant bacteria in the medical unit have led most authorities to conclude that
antibiotics are not useful for prevention of
bacteriuria, nor for treatment of
bacteriuria in the asymptomatic catheterized patient. For symptomatic patients, usually with
fever or signs of
sepsis, treatment of
bacteriuria with appropriate systemic
antibiotics and removal or replacement of the
urethral catheter are indicated. Gloves, hand washing, and segregation of catheterized patients can minimize nosocomial clusters. Because clinicians can only postpone
bacteriuria, and once it occurs, clinicians seem unable to prevent its complications, methodologies other than
urethral catheters should be used for urine drainage assistance whenever possible. These options include
condom, intermittent, suprapubic, and intraurethral catheterization for appropriate patients. The few data available suggest that each one of these catheterization options yields a lower incidence of
bacteriuria-and its consequent complications-than urethral catheterization.