Asymptomatic bacteriuria persisting after catheter removal: are we missing the true catheter associated urinary tract infection burden?

Abstract

Introduction: Catheter Associated Asymptomatic Bacteriuria persisting beyond 48 hours after catheter removal predisposes to the development of catheter associated urinary tract infections, necessitating treatment. Current surveillance strategies do not screen for infection detection after catheter removal, missing most of the clinically significant catheter associated urinary tract infection cases.

Methodology: The study reports findings of a pilot, short-term, cross-sectional study conducted on patients who underwent indwelling urinary catheterization for any of the recognized indications. Surveillance for catheter associated urinary tract infections was done as per Centre for Disease Control and Prevention, National health and safety network protocols starting from two days onwards until the entire period of catheterization. Patients who remained asymptomatic during the period of catheterization were further screened for catheter associated asymptomatic bacteriuria at 48 hours after catheter removal and followed up for development of signs and symptoms suggestive of urinary tract infections. Catheter associated urinary tract infection rates were calculated with and without inclusion of catheter associated asymptomatic bacteriuria and compared.

Results: Screening for catheter associated asymptomatic bacteriuria at 48 hours of catheter removal significantly (p = 0.00021) improved the catheter associated urinary tract infection rates from 2.67 to 8.01 per 1,000 catheter days. Approximately 75% of patients with catheter associated asymptomatic bacteriuria after catheter removal became symptomatic for UTIs on follow-up.

Conclusions: Diagnosing catheter associated asymptomatic bacteriuria at 48 hours after catheter removal can improve the surveillance process and identify impending urinary tract infections early in the course of the disease.