Nosocomial catheter-associated urinary tract infections in the intensive therapy unit: physiopathology, epidemiology and prophylaxis

Objectives: Nosocomial urinary tract infections associated with bladders ca theters are common and poorly understood. Data on the prevention of urinary tract infections are numerous and heterogenous. This update article aimed at analysing mechanisms, epidemiology and prevention of these infections. Data sources: We searched in the Medline(R) database for articles in Englis h or French, without limiting date of publication, using the following key words separely or in combination: urinary tract infection, nosocomial, cath eter, infection urinaire, sonde urinaire. Study selection: We considered all categories of articles. Data extraction: Data on prevention of nosocomial urinary tract infections were analysed in depth. Data synthesis: The data on pathogenesis of nosocomial urinary tract infect ions are still controversial. Various means for preventing urinary tract in fections have been recommended : addition of antibacterial agents to urinar y drainage system, inclusion of antimicrobial components into the catheter itself, antibiotic prophylaxis or closed sterile drainage system. Their eff iciency in intensive therapy unit has not yet been fully assessed. The ther apy of these infections is still under debate and requires additional prosp ective studies to establish the optimal management. Conclusion: Catheter-associated urinary tract infections reflect the genera l hygiene policy, starting with nurse practice patterns at catheter inserti on, and ending with antibiotherapy prescriptions by medical staff. (C) 2000 Editions scientifiques et medicales Elsevier SAS.