Urinary Tract Infection – CAUTIs

Urinary Tract Infection – CAUTIs

Medicated Foley Catheters Do Not Prevent Catheter-Associated Urinary Tract Infection: A Systematic Review of Randomized Controlled Trials.

Infections of the urinary tract are among some of the most common infections treated in clinical practice. Numerous risk factors play an intrinsic role in the development of such infections, namely: age, sexual intercourse, prolonged use of feminine hygiene products, instrumentation, pregnancy, sexually transmitted infections, obstructive uropathy such as prostatic enlargement or urethral strictures, compromised immunity, and constipation.

Impact of Introducing External Urinary Devices on Reducing Indwelling Urinary Catheter Days - A Quality Improvement Initiative at a Midwestern Academic Medical Center.

External urinary device (EUD) use and modification of the Electronic Medical Record (EMR) system with defaulting EUD for selected indications significantly decreased the utilization of indwelling urinary catheters while there was no observed significant reduction in Catheter-Associated Urinary Tract Infections (CAUTI).

Bladder catheterization improves bacterial interference with asymptomatic Escherichia coli 83972 in an experimental porcine model of urinary tract infection.

Urinary tract infection (UTI) is a common disease with a significant risk of relapse. Deliberate bladder colonization with asymptomatic Escherichia coli is being explored as a potential strategy to fend off invading uropathogens thereby mitigating the risk symptomatic UTI.

The catheterized bladder environment induces dysregulation of macrophage polarization exacerbating bacterial UTI.

Urinary catheterization causes bladder damage, predisposing hosts to catheter-associated urinary tract infections (CAUTIs). CAUTI pathogenesis is mediated by bladder damage-induced inflammation, resulting in accumulation and deposition of the blood-clotting protein fibrinogen (Fg) and its matrix form fibrin, which are exploited by uropathogens as biofilm platforms to establish infection.

A nurse-led multifaceted intervention for the optimal use of indwelling urinary catheters at a tertiary care center: A before-after trial.

Few interventional studies of catheter-associated urinary tract infection (CAUTI) have been conducted to optimize indwelling urinary catheter (IUC) use in Japan.

The nurse-led, before-after study was conducted at a tertiary care center from June 2018 through May 2022.

Assessment of a Protocol for Reducing Indwelling Urinary Catheter Usage: Reduced Infection Without Increased Acute Kidney Injury.

Introduction In 2019, a level one trauma center in St. Louis, Missouri launched a campaign to reduce the use of indwelling urinary catheters (IUC) in the trauma population. Our study assesses whether the campaign achieved the intended effect of reducing catheter-associated urinary tract infection (CAUTI) and whether this came at the cost of increased acute kidney injury (AKI).

Draft genome sequences of an Enterobacter hormaechei and Providencia rettgeri isolated from the urine of a male experiencing a catheter-associated urinary tract infection.

Catheter-associated urinary tract infections (CAUTIs) can be caused by a variety of microbes. Here, we describe the draft genome assemblies of two species-Enterobacter hormaechei and Providencia rettgeri-purified from the catheterized urine sample of a male diagnosed with a CAUTI.

Dual-Layer Nanoengineered Urinary Catheters for Enhanced Antimicrobial Efficacy and Reduced Cytotoxicity.

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection; however, current therapeutic strategies remain insufficient for standard clinical application.

Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis

Background and objective: With over 50% of women suffering from at least one episode of urinary tract infection (UTI) each year and an increasing prevalence of antimicrobial resistance, efforts need to be made to clearly identify the evidence supporting potential non-drug interventions. This study aims to compare the effects of cranberry juice, cranberry tablets, and increased liquids for the management of UTIs.

Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial.

Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness.

"Catheter replacement in catheter-associated urinary tract infection: current state of evidence ".

Catheter associated urinary tract infection (CAUTI) is the most common healthcare associated infection. A significant knowledge gap exists regarding the necessity of catheter replacement as part of CAUTI treatment.

Multidisciplinary Development and Implementation of a Trial of Void Algorithm to Standardize and Reduce Indwelling Urethral Catheter Use.

Prolonged indwelling catheter use is a known risk factor for catheter-associated UTIs (CAUTIs). We sought to reduce catheter use by creating and implementing a trial of void (TOV) algorithm to standardize indwelling Foley catheter removal in surgical patients.

Urinary catheter alleviation navigator protocol (UCANP): Update to the hospital-wide implementation at a single tertiary health care center.

Catheter-associated urinary tract infections (CAUTIs) are commonly reported healthcare-associated infections. It was demonstrated that the urinary catheter alleviation navigator protocol (UCANP) pilot resulted in a reduction of catheter utilization and catheter days.

International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module.

Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East.

Function and contribution of two putative Enterococcus faecalis glycosaminoglycan degrading enzymes to bacteremia and catheter-associated urinary tract infection.

Enterococcus faecalis is a common cause of healthcare-acquired bloodstream infections and catheter-associated urinary tract infections (CAUTIs) in both adults and children. Treatment of E. faecalis infection is frequently complicated by multi-drug resistance.

When Infections Are Found: A Qualitative Study Characterizing Best Management Practices for Central Line-Associated Bloodstream Infection and Catheter-Associated Urinary Tract Infection Performance Monitoring and Feedback.

Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood.

Function and contribution of two putative Enterococcus faecalis glycosaminoglycan degrading enzymes to bacteremia and catheter-associated urinary tract infection.

Enterococcus faecalis is a common cause of healthcare acquired bloodstream infections and catheter associated urinary tract infections (CAUTI) in both adults and children. Treatment of E. faecalis infection is frequently complicated by multi-drug resistance.

Clinical outcomes of female external urine wicking devices as alternatives to indwelling catheters: a systematic review and meta-analysis.

Female patients using indwelling urinary catheters (IUCs) are disproportionately at risk for developing catheter-associated urinary tract infections (CAUTIs) compared to males. Female external urine wicking devices (FEUWDs) have emerged as potential alternatives to IUCs for incontinence management.

F.D.A. Approves Antibiotic for Increasingly Hard-to-Treat Urinary Tract Infections

Pivmecillinam, which has been used in Europe for decades, will become available next year to women 18 and older.

A colored scanning electron micrograph showing bacteria in a urine sample.Credit...Steve Gschmeissner/Science Source

The Food and Drug Administration on Wednesday approved the sale of an antibiotic for the treatment of urinary tract infections in women, giving U.S. health providers a powerful new tool to combat a common infection that is increasingly unresponsive to the existing suite of antimicrobial drugs.

The drug, pivmecillinam, has been used in Europe for more than 40 years, where it is often a first-line therapy for women with uncomplicated U.T.I.’s, meaning the infection is confined to the bladder and has not reached the kidneys. The drug will be marketed in the U.S. as Pivya and will be made available by prescription to women 18 and older.

It is the first time in two decades that the F.D.A. has approved a new antibiotic for U.T.I.s, which annually affects 30 million Americans. U.T.I.s are responsible for the single-greatest use of antibiotics outside a hospital setting.

“Uncomplicated U.T.I.s are a very common condition impacting women and one of the most frequent reasons for antibiotic use,” Dr. Peter Kim, director of the Division of Anti-Infectives at the F.D.A.’s Center for Drug Evaluation and Research, said in a statement. “The F.D.A. is committed to fostering new antibiotic availability when they prove to be safe and effective.”

Utility Therapeutics, the U.S. company that acquired the rights to pivmecillinam, said it would be available in 2025. The company is also seeking F.D.A. approval for an intravenous version of the drug that is used for more serious infections and is usually administered in a hospital setting.

Health practitioners said they were elated to have another tool in their arsenal given the growing challenge of antimicrobial resistance, which makes existing medications less effective as pathogens mutate in ways that allow them to survive a course of antibiotics.

The problem, largely an outgrowth of antibiotic overuse around the world, is associated with five million deaths, according to the World Health Organization.

“This is an exciting new possibility for treatment of lower urinary tract infections,” said Dr. Shruti Gohil, a professor of infectious diseases at the University of California, Irvine School of Medicine, and an author of a recent study in JAMA that focused on ways to reduce antibiotic overuse in hospitals. “But I would also say that it is going to be important that we use the drug responsibly in this country so that we don’t breed resistance against it.”

Most U.T.I.s occur when bacteria like E. coli travel from the rectum, genital area or vagina into the urethra and enter the bladder. As they multiply, the pathogens can cause abdominal cramping, burning, and bloody urination.

More than half of all women in the United States will acquire a U.T.I. in their lifetime, compared with 14 percent of men. That is in large part because of the differing architecture of the urinary tract in the sexes: Women have shorter urethras than men, which makes it easier for bacteria to reach the urinary tract.

The majority of U.T.I.s are now resistant to one or more antibiotics; ampicillin, once a common treatment, has been largely abandoned. Infections that travel to the kidneys or that enter the bloodstream are more difficult to treat and more dangerous.

People with weakened immune systems or chronic medical conditions are usually the most vulnerable to drug-resistant infections. But U.T.I.s have a dubious distinction: They are the single biggest risk to healthy people from drug-resistant germs.

In the four decades since it was first approved for use in Europe, Pivmecillinam has been prescribed more than 30 million times, mostly in Nordic countries, with few reported complications.

The F.D.A. said that nausea and diarrhea were the most common side effects in the clinical trials that paved the way for pivmecillinam’s approval in the United States.

Tom Hadley, the president and chief operating officer of Utility Therapeutics, said his company moved to acquire the U.S. rights to pivmecillinam after Congress, in 2012, granted an additional five years of exclusivity to manufacturers of new antimicrobial drugs.

Henry Skinner, the chief executive at the AMR Action Fund, a venture capital fund that invested in Utility Therapeutics’ bid to bring pivmecillinam to the U.S., said he was gratified by the F.D.A.’s approval but said the long-term prognosis for new antimicrobial drugs remained grim. The $1 billion fund, financed by the pharmaceutical industry, invests in biotech start-ups working on promising antimicrobials.

Most of the nation’s biggest drug makers, unable to turn a profit on antibiotics, have long since abandoned the field, he said, and the dearth of investment has prompted an exodus of talented researchers.

A federal initiative that would create a subscription-based model for antibiotic development has been languishing in Congress. The $6 billion measure, the Pasteur Act, would provide pharmaceutical companies an upfront payment in exchange for unlimited access to a drug once it is approved by the F.D.A.

Mr. Skinner said he was haunted by one recent estimate suggesting that drug-resistant infections could claim 10 million lives by 2050.

“There are definitely bright spots,” he said. “But more people are dying today than ought to be because we are moving backward, and not delivering the physicians, drugs and diagnostics needed to address the crisis of antimicrobial resistance.”

By: Andrew Jacobs

Source: The New York Times. (2024). F.D.A. Approves Antibiotic for Increasingly Hard-to-Treat Urinary Tract Infections [Press release]. https://www.nytimes.com/2024/04/24/health/fda-urinary-tract-infection-antibiotic.html.

Implementation of a multi-modal intervention adopting new technologies, clinical services, and feedback improves catheter-associated urinary tract infections.

Catheter-associated urinary tract infections (CAUTI) are a significant cause of morbidity and financial burden to healthcare systems. The aim of this study was to develop and implement a program designed to reduce Foley catheter use days and associated CAUTI rates.

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