Health Care-Associated Urinary Tract Infections

Urinary tract infections are the most commonly reported health care-associated infections, and the majority of these are associated with urinary catheter use. Although a strict definition of catheter-associated urinary tract infection (CAUTI) requires the presence of symptoms related to the urinary tract, most cases of catheter-associated bacteriuria occur in asymptomatic patients (asymptomatic bacteriuria [ASB]). CAUTI merits intervention and treatment to relieve symptoms, while ASB should not be treated in most situations, unless the patient is pregnant or undergoing a urologic procedure that can cause mucosal bleeding. In practice, ASB is often misdiagnosed as CAUTI and treated unnecessarily with antimicrobials. CAUTI prevention has received considerable emphasis, and the most effective approach is to reduce unnecessary catheterization, either avoiding unnecessary catheter placement or removing catheters when no longer needed. Given the wide spectrum of organisms that cause CAUTI and the frequent occurrence of multidrug resistance in these pathogens, antimicrobial management of CAUTI requires tailoring to the known resistance patterns of the health care setting and ultimately to the individual patient. Funguria, usually caused by Candida spp., is very common in catheterized patients and usually asymptomatic. However, funguria, like bacteriuria, can lead to invasive disease in the bladder, kidneys, or bloodstream that necessitates treatment.