CAUTI is defined as significant bacteriuria in patients with urinary symptoms related to catheterization, with risk factors including device, patient, and caregiver elements. The most common pathogens are E. coli and other bacteria, with the risk of infection increasing with the duration of catheter use. Prevention relies on proper training of healthcare workers, appropriate catheter choice and maintenance, and strict aseptic techniques during insertion.

1. CAUTI

2. Definition
It is defined as the presence of significant
bacteriuria in a catheterized or recently
catheterized patient with signs and
symptoms relatable to the urinary tract.
CA-ASB (Catheter associated
asymptomatic bacteriuria) is a CAUTI
without signs and symptoms localising to
the urinary tract.

3. Risk Factors
1. Device related
2. Patient related
3. Caregiver related
Device Related Risk Factors
- Presence and duration of catheterization
- Type of catherization
- Long term indwelling catheters
- Type of catheter material
-Silicone better than latex
Patient Related Risk Factors
- Female gender
- Serious underlying illnesses
- Age > 50 years
- Diabetes mellitus
- Elevated creatinine (AKI)
- Poor personal hygiene
- Urethral Colonization
- Fecal incontinence
Caregiver Related Risk Factors
- Emergency catheter insertion
- Improper technique/failure of adherence
to aseptic technique

4. Bacteria implicated in CAUTI
In short term catheterized patients:
- E. coli
- Others, Klebsiella, Serratia, Citrobacter, Enterobacter,
Pseudomonas, Acinetobacter, CoNS, Enterococcus
- Candiduria, rare and its significance is doubtful.
In long term catheterized patients:
- usually polymicrobial
- Above mentioned organisms + Proteus, Providencia,
Morganella etc

5. Pathogenesis
the four major
portals of entry

7. Source of flora/spread of flora:
- Extraluminal spread:
- Accounts for 2/3rd
of cases
- Patients endogenous flora, hands of
the HCW is asepsis is not maintained
(NOTE: usually the flushing action of urine prevents
extraluminal migration)
- Intraluminal spread:
- Accounts for 1/3rd
of cases
- Reflux of urine from the bag/tubing system

8. Struvite stones

9. Why does an indwelling catheter
increase the risk of a UTI?
Presence of a urinary catheter is the single most
important risk factor for a UTI
The risk is directly proportional to the duration of
catherization
Urethral pressure – decreases mucosal blood
flow, urothelial mucosal disruption, impaired
mucin secretion
Incomplete emptying – pooling around the
balloon serving as a nidus of infection
Biofilm formation on the catheter surface

10. Diagnosis

12. Prevention
Measures prior to Catheterization:
Regular training of HCWs on insertion and maintenance
Choosing the correct catheter
- Appropriate indications
- Material
- Size
- Alternatives to indwelling catheters
Measures during catheterization: PROPER TECHNIQUE

13. Measures after catheterization:
Closed drainage system:
Bag below bladder, above the floor
Legs bags
Emptying, alcohol swab for outlet
Hand hygiene and PPE
Meatal care – soap and water 2/3 times a day
Removal of catheter
Bladder irrigation – only when indicated not routine

14. Care Bundle for UTI