This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Barford, J. Articles by Coates, A. Search for Related Content Social Bookmarking                         What's this?

The pathogenesis of catheter-associated urinary tract infection

Medical Microbiology, Centre for Infection, Division of Cellular and Molecular Medicine, St George's, University of London, Email: jbarford{at}sgul.ac.uk

ARM Coates

Medical Microbiology, Centre for Infection, Division of Cellular and Molecular Medicine, St George's, University of London, Email: jbarford{at}sgul.ac.uk

Catheter-associated urinary tract infection (CAUTI) remains one of the most common types of hospital-acquired infections. Further progress in the prevention of CAUTI requires a better understanding of its pathogenesis. Bacteria may enter the bladder through contamination of the tip during insertion with the flora of the distal urethra or from bacteria ascending the outside or the inside of the catheter. Residual urine in the bladder of catheterised patients increases the risk of bacteriuria. During the process of infection, bacteria need first to adhere to the epithelial cells of the urinary tract and/or the surface of the catheter. They will then develop into biofilms on the catheter surface and are resistant to the immune system and antibiotics. Catheters by themselves may cause immediate physical damage to the bladder epithelium; they may be toxic and also cause inflammation. Bacteria can also damage the epithelium and cause inflammation and the combination of both may be synergistic in producing symptoms in the patient. Most episodes of catheter-associated bacteriuria are asymptomatic but it is not known why some patients are symptomatic and others are not. Further research into the pathogenesis of CAUTI needs to be carried out. A suggestion for the prevention of CAUTI is the use of catheters with an additional eye-hole beneath the balloon to prevent residual urine in the bladder or to remove the tip and balloon altogether, with the additional benefit of having no tip to cause damage or inflammation to the bladder epithelium.

Key Words: Urinary catheterisation • urinary tract infection • bacteriuria • aetiology

Journal of Infection Prevention, Vol. 10, No. 2, 50-56 (2009)
DOI: 10.1177/1757177408098265


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?