Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit

Urinary tract infection is the most common healthcare-associated infection in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. The predominant microorganisms causing catheter-associated urinary tract infection (CAUTI) in the intensive care unit are enteric Gram-negative bacilli, enterococci, Candida species, and Pseudomonas aeruginosa. Multidrug resistance is a significant problem in urinary pathogens. Duration of catheterization is the most important risk factor for development of CAUTI. Diagnosis, particularly in the intensive care unit setting, is very difficult, as asymptomatic bacteriuria may be difficult to differentiate from symptomatic CAUTI. In general, asymptomatic bacteriuria should not be treated, and treatment of CAUTI often requires removal of the catheter along with systemic antimicrobial therapy. General strategies for prevention of CAUTI apply to all healthcare-associated infections and include measures such as adherence to hand hygiene. Targeted strategies for prevention of CAUTI include limiting the use and duration of urinary catheterization, using aseptic technique for catheter insertion, and adhering to proper catheter care. (Crit Care Med 2010; 38[Suppl.]:S373-S379)