Millions of people around the world use urinary catheters every day. The tubes running in and out of their bodies provide a safe way out for urine but leave people constantly open to the risk of infection.
A species of bacteria called Proteus mirabilis is particularly adept at building crusty scaffolds that eventually block the catheter tubes. We call these layers of bacteria biofilms and they are a serious problem; out of reach of the immune system and impenetrable to antibiotics, they thrive on medical devices.
An estimated 100 million catheters are fitted every year globally, a quarter of these in the US. They are by far the most commonly used medical devices that stay inside the body.
Up to half of people who use catheters long-term will at some point experience a blockage. This is bad news. When a catheter blocks, urine can no longer drain into the collection bag and so pushes back up from the bladder into the kidneys. There the bacterial infection builds where it can cause kidney failure, septicemia and death.
Many people who use catheters long-term do so at home, or in a care-home setting, where they don’t have access to clinical expertise. One of the advantages of our system is this visual clue, which can be spotted by anyone, regardless of their training.
The 2009 Centers for Disease Control and Prevention (CDC) guidelines for prevention of catheter-associated urinary tract infections (UTIs) recommends catheter use only for appropriate indications. Catheter use and duration should be minimized in all patients, especially those at higher risk for catheter-associated UTI (eg, women, elderly persons, and patients with impaired immunity). 
Catheters should be kept in place only for as long as needed. Indwelling catheters placed in patients undergoing surgery should be removed as soon as possible postoperatively. The use of urinary catheters for treatment of incontinence in patients and nursing home residents should be avoided.
The 2009 CDC guidelines recommend that clinicians avoid using systemic antimicrobials routinely to prevent catheter-associated UTI in patients requiring either short- or long-term catheterization.
The 2009 Infectious Diseases Society of America (IDSA) guidelines for catheter-associated UTIs state that an indwelling catheter may be used at the patient’s request in exceptional cases and when other approaches to incontinence management have been ineffective.
Long-term catheterization increases patient satisfaction but also increases mechanical complications. Contraindications include bleeding disorders, previous lower abdominal surgery or irradiation, and morbid obesity. Intermittent catheterization is an option, but most patients become bacteriuric within a few weeks; the incidence of bacteriuria is 1-3% per insertion.
According to the 2009 IDSA guidelines, if an indwelling catheter has been in place for more than 2 weeks at the onset of catheter-associated UTI and remains indicated, the catheter should be replaced to promote continued resolution of symptoms and to reduce the risk of subsequent catheter-associated infection.
Because infection rates are so high in people who use catheters, people are often given antibiotics to try to prevent infection. There are even catheters available that are impregnated with antibiotics. However, this is controversial given the increasing problem of antibiotic resistance: using antibiotics to prevent, rather than treat, infection can reduce their efficacy and contribute to resistance.
Below are the signs of infection:
- cloudy urine
- blood in the urine
- strong urine odor
- urine leakage around your catheter
- pressure, pain, or discomfort in your lower back or stomach
- unexplained fatigue
Infections can be difficult to diagnose but if you experience any of the above symptoms, do not hesitate to contact your health care provider.
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