Prevention and treatment of urinary catheter-related infections in older patients

The elderly population is more likely to have urinary catheters used than younger populations. Most patients with short term indwelling catheters (those in place less than 30 days) will be residents of acute care institutions. The frequency of catheter-acquired bacteriuria is greater with longer durations of catheterisation, female gender, failure to maintain a closed drainage system, and in patients not receiving systemic antimicrobials. Systemic antimicrobials given within 48 hours of catheter removal decrease the incidence of urinary infection, but are not currently recommended because of concerns with antimicrobial resistance. Interventions such as topical meatal antimicrobials, disinfectants added to the urinary drainage bag, antimicrobial coatings for catheters, and antimicrobial irrigation have not been shown to decrease the incidence of infection. Asymptomatic bacteriuria should not be treated while the catheter remains in place. However, catheter-acquired bacteriuria should probably be treated following catheter removal. Long term indwelling catheters are most frequently used in elderly individuals resident in long term care institutions. These individuals are always bacteriuric, usually with a complex polymicrobial flora. There are no clinical benefits of treatment of asymptomatic bacteriuria in such persons. In fact, treatment will promote the emergence of resistant organisms. The optimal management of symptomatic infection has not been defined.