Thursday, January 7, 2016

Preventing CAUTIs- Still Looking for the Magic Fix

There is no single best way to prevent catheter associated urinary tract infections (CAUTIs) with the exception of not using urinary catheters. Admittedly, urinary catheters are overused, however, some people actually need them and are thus at risk for a CAUTI.

Strategies such as standardized catheter insertion and automatic electronic medical record generated stop orders reduce risk and limit unnecessary catheter use. Silver impregnated catheters limit bioburden and also reduce risk but are not salvation from urinary colonization and infection.

This recent article published in The Lancet Infectious Diseases evaluated body surface decolonization with chlorhexidine bathing on bacteriuria and CAUTIs in a cluster-randomised trial of 43 hospitals (clusters) with patients in 74 adult ICUs. The number of patients assessed was impressive (122,646). Universal decolonization of patients in the ICU with once a day chlorhexidine baths and short-course nasal mupirocin  decreased candiduria and bacteriuria yet not infection in men only. This is no slam dunk.

The authors note that decreasing urinary colonization may have the secondary impact of decreasing unnecessary antibiotic use. This has yet to be proven but is tantalizing.

Again, we are still looking for new and improved strategies to prevent CAUTIs. The magic fix has yet to materialize.

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