Objective
To determine the pathogenesis of catheter-associated urinary tract infection (CAUTI)
and the relative importance of each of the possible mechanisms of entry of infecting
microorganisms to the catheterized urinary tract.
Material and Methods
We conducted a prospective study of 1,497 newly catheterized patients. Paired quantitative
urine cultures were obtained daily, from the catheter specimen port and from the collection
bag, using a technique that could detect 1 colony-forming unit/mL. We assumed that
with extraluminal infections, caused by microorganisms ascending from the perineum
in the mucous film contiguous to the external surface of the catheter, the organisms
would be detected first in bladder urine or in far higher concentrations in urine
from the specimen port than from the collection bag. With intraluminal CAUTIs, caused
by microorganisms gaining access to the catheter lumen because of failure of closed
drainage or contamination of collection bag urine, the organisms would be detected
first or in far larger numbers in a collection bag specimen.
Results
The probable mechanism of infection could be determined for 173 of 250 organisms (69.2%)
identified in 235 new-onset CAUTIs. Among these 173 cases, 115 (66%) were extraluminally
acquired, and 58 (34%) were derived from intraluminal contaminants. For these determinable
cases, CAUTIs caused by gram-positive cocci (enterococci and staphylococci) and yeasts
were far more likely to be extraluminally acquired (extraluminal:intraluminal, 2.9)
than were gram-negative bacilli, which caused CAUTIs by both routes equally (extraluminal:
intraluminal, 1.2; P = 0.007). Surprisingly, no significant differences were noted in pathogenetic mechanisms
between men and women.
Conclusion
We conclude that, in both men and women, CAUTIs occur by both extraluminal and intraluminal
portals of entry but derive preponderantly from organisms that gain access extraluminally.
Strategies for prevention of CAUTIs must focus on new technologies to prevent access
of organisms by all possible routes.
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Article Info
Footnotes
This study was supported in part by grants from the Miami Heart Research Institute, the Bruce and Ruth Rappaport Program in Vascular Biology, the National Institutes of Health, Public Health Service (HL-36634), and the Mayo Foundation.
Identification
Copyright
© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
