Urinary tract infections (UTIs) are the most common type of health care associated infection reported to the National Healthcare Safety Network, according to the Centers for Disease Control and Prevention. And among UTIs diagnosed in hospitals, the majority are associated with a urinary catheter.
Brian Schwartz, MD, associate professor and Vice Chief for Clinical Affairs at the University of California, San Francisco, Division of Infectious Diseases, will moderate a panel discussion on catheter associated UTIs during Sunday afternoon’s Next Frontier plenary session. Dr. Schwartz and three infectious disease specialists will review guidelines for their prevention, diagnosis and treatment of catheter associated UTIs during the 30-minute discussion, which will begin at 1:45 pm in in Hall E at Moscone North.
In 2014 the AUA published a white paper on catheter associated UTIs and their significance in the urological patient. In the white paper the authors acknowledged that changes in how UTIs are defined and diagnosed make it difficult to understand the true prevalence of catheter associated UTIs.
“Diagnosis is definitely one of the biggest challenges in the field,” Dr. Schwartz said. “We probably over diagnose UTIs very often.”
Urine samples taken from patients with catheters often show an increase in bacteria and white blood cells, but that does not necessarily mean the patient has a UTI.
“It can be hard to distinguish infection from colonization, where bacteria is present but is not causing the disease or its symptoms,” Dr. Schwartz said.
The European Association of Urology (EAU) has revised its definition of catheter associated UTIs to help address overreporting of postoperative UTIs. EAU guidelines provide “specific laboratory testing recommendations (microscopy) and colony count criteria based on the method of urine collection.” The EAU requires two consecutive positive urine cultures at least 24 hours apart in asymptomatic patients.
UTI prevention measures include appropriate patient selection for catheter placement, timely removal of the catheters and improved techniques for catheter insertion. Treatment can complicated by antibiotic resistance. In fact, the EAU recommends against treatment of asymptomatic bacteriuria in any patient due to widespread problems with resistant bacterial strains.
“Patients who have catheters and multiple infections tend to get a lot of antibiotics or have recurrent infections,” Dr. Schwartz said. “They can build up resistance to antibiotics and experience the side effects and toxicities associated with increased use.”
Dr. Schwartz will be joined by panelists Tomas Griebling, MD, MPH, Senior Associate Dean for Medical Education at the University of Kansas School of Medicine; Dirk Lange, PhD, a microbiologist at the University of British Columbia; and Timothy Averch, MD, FACS, associate professor of Urology and Director of Endourology at the University of Pittsburgh Medical Center.