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J Clin Outcomes Manage
2005 Jun;12(6):306-314
Management of nosocomial urinary tract infections in adult patients
Belliveau PP, DeBellis RJ
Abstract Objective: To review the literature on the management of nosocomial urinary tract infections (UTIs) and propose guidelines for their treatment. Methods: MEDLINE search for English-language articles published between 1966 and August 2004 using the medical subject heading “urinary tract infections” or “urinary catheterization” combined with the term “nosocomial infection” or “hospital-acquired infection.” Results: UTIs are common in hospitalized patients, accounting for approximately 25% to 35% of nosocomial infections. The risk of nosocomial bacteriuria is greatest in women and in patients who have urinary catheters. The medical literature does not provide clear direction regarding appropriate management of nosocomial UTIs. Our guideline recommends that in situations in which urine culture results are available, treatment is indicated if the patient has symptoms of a UTI. In the absence of symptoms, workup and treatment are dependent on whether there is a urinary catheter in place. Treatment is not recommended for asymptomatic catheterized patients (although clinicians may consider changing or removing the catheter) unless the patient is pregnant or scheduled to have an invasive urologic procedure. In the asymptomatic patient without a urinary catheter, the urine culture should be repeated. Therapy should be initiated for the female patient whose follow-up urine culture contains at least 100,000 cfu/mL of bacteria. For situations in which urine culture results are not available and a UTI is suspected, we recommend that clinicians obtain urine for urinalysis and culture. If the patient has symptoms that are consistent with a urinary source of infection and pyuria is documented, treatment is recommended. Conclusion: The literature provides little definitive guidance for the management of nosocomial UTIs. Further investigation is required in the areas of diagnosis, treatment, and prognosis.
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