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Guideline Summary
Guideline Title
Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America.
Bibliographic Source(s)
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63. [299 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

FDA Warning/Regulatory Alert

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • August 15, 2013 – Fluoroquinolone Antibacterial Drugs External Web Site Policy: The U.S. Food and Drug Administration (FDA) has required the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy. This serious nerve damage potentially caused by fluoroquinolones may occur soon after these drugs are taken and may be permanent.

Scope

Disease/Condition(s)

Catheter-associated urinary tract infection

Guideline Category
Diagnosis
Evaluation
Management
Prevention
Treatment
Clinical Specialty
Critical Care
Emergency Medicine
Family Practice
Infectious Diseases
Internal Medicine
Preventive Medicine
Urology
Intended Users
Advanced Practice Nurses
Hospitals
Managed Care Organizations
Nurses
Physician Assistants
Physicians
Guideline Objective(s)

To provide evidence based recommendations for diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic

Target Population

Patients with catheter-associated urinary tract infections

Interventions and Practices Considered

Diagnosis

  1. Assessment of symptoms or signs
  2. Urine specimen culture

Management/Treatment

  1. Limit unnecessary catheterization
  2. Removal of indwelling catheters as soon as no longer required
  3. Development of institutional strategies for infection prevention
  4. Alternatives to indwelling urethral catheterization (condom catheterization, suprapubic catheterization)
  5. Intermittent catheterization
  6. Indwelling urethral catheterization (aseptic technique, sterile equipment)
  7. Prevention strategies after catheter insertion
    • Closed catheter system
    • Antimicrobial coated catheters
    • Prophylaxis with methenamine salts (in patients after gynecological surgery)
    • Catheter irrigation (in select patients)
  8. Urine culture and catheter replacement prior to treatment initiation
  9. Duration of antimicrobial treatment

Note: Prophylaxis with systemic antimicrobials and cranberry products, enhanced meatal care, antimicrobials in the drainage bag, and prophylactic antimicrobials at time of catheter removal or replacement were considered but not recommended.

Major Outcomes Considered
  • Resolutions of symptoms
  • Morbidity and mortality
  • Avoidance of complications
  • Efficacy of anti-infective therapy
  • Sensitivity and specificity of diagnostic tests

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Literature Review and Analysis

The recommendations in these guidelines have been developed after a review of studies published in English, although foreign language articles were included in some of the Cochrane reviews summarized in these guidelines. Studies were identified through a PubMed search with no date restrictions using subject headings "urinary" combined with the keyword "catheter," other keywords such as "nosocomial," "neurogenic bladder," "intermittent," "suprapubic," and "methenamine," supplemented by review of references of relevant articles to identify additional reports, particularly early studies not accessed through the PubMed search. In addition, experts in urinary infection were asked to identify any additional trials not accessed through the review. Clinical studies include prospective randomized clinical trials, prospective cohort studies, case-control studies, and other descriptive studies. Studies were excluded if the study population, intervention, or study design were not clearly described; if procedures for patient follow-up or exclusions may have introduced sufficient bias to limit the credibility of observations; or if there were insufficient patients enrolled to support valid statistical analysis. Conclusions from meta-analyses, such as Cochrane reviews, were included.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Quality of Evidence

  1. Evidence from >1 properly randomized, controlled trial
  2. Evidence from >1 well-designed clinical trial without randomization, from cohort or case-controlled analytic studies (preferably from >1 center), from multiple time-series studies, or from dramatic results of uncontrolled experiments
  3. Evidence from opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence

To evaluate evidence, the Panel followed a process consistent with that of other Infectious Diseases Society of America (IDSA) guidelines. This process included a systematic weighting of the quality of the evidence and the grade of recommendation.

Initial findings were discussed by the Panel, and final recommendations were determined by consensus. Each Panel member was assigned 1 or more proposed sections of the guidelines, so that each such section was assigned to 2 or more Panel members, and each Panel member was asked to review the literature for that section and to critique the strength of the recommendation and quality of evidence for each recommendation that had been proposed by 1 or more other Panel members for that section.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee (SPGC) convened a multidisciplinary panel of experts in the management of catheter-associated urinary tract infection (CA-UTI). Panel participants included representatives from the following collaborating organizations: American Geriatrics Society, American Society of Nephrology, American Spinal Injury Association, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, European Association of Urology, European Society of Clinical Microbiology and Infectious Diseases, Society for Healthcare Epidemiology of America, Society of Hospital Medicine, and the Western Pacific Society of Chemotherapy.

The Panel met on 2 occasions for face-to-face meetings and on 3 occasions via teleconference to complete the work of the guidelines. The purpose of the teleconferences was to discuss the questions to be addressed, assign topics for review and writing of the initial draft, and discuss recommendations. Much of the work was done with e-mail correspondence.

The full Panel was asked to review all recommendations, their strength, and the quality of evidence. Discrepancies were discussed and resolved, and all Panel members are in agreement with the final recommendations.

Any combination of Strength of Recommendation and Quality of Evidence is possible. For example, a recommendation can have Strength A even if it is based entirely on expert opinion and no research studies have ever been conducted on the recommendation (Quality of Evidence III). Similarly, a Strength B or C can be assigned a Quality of Evidence I if there are multiple randomized, controlled trials that arrive at divergent conclusions. Assigning a Quality of Evidence II or III should not be construed as implying that the recommendation is weak. Many important clinical questions addressed in guidelines either do not lend themselves to experimentation or have not yet been addressed by high-quality investigations. Even though randomized, controlled trials may not be available, the clinical question may be so relevant that it would be delinquent to not include it in the guidelines. Often the Quality of Evidence will parallel the Strength of Recommendation, but this is not necessarily the case.

Rating Scheme for the Strength of the Recommendations

Strength of Recommendation

  1. Good evidence to support a recommendation for or against use
  2. Moderate evidence to support a recommendation for or against use
  3. Poor evidence to support a recommendation for or against use
Cost Analysis

In recent studies conducted in the era of managed care, each episode of catheter-associated asymptomatic bacteriuria (CA-ASB) and catheter-associated urinary tract infection (CA-UTI) has been estimated to cost an additional $589 and $676, respectively, and bacteremia associated with CA-bacteriuria is estimated to cost at least $2,836. Although the costs associated with individual episodes of bacteriuria are modest, the high frequency of catheter use means that these infections may add as much as $500 million to health care costs in the United States each year. However, episodes of CA-ASB that are not detected by surveillance cultures do not add to hospital costs, and thus, these costs, which are based on surveillance cultures that are not routinely recommended or performed, may well be overestimated.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

All members of the Expert Panel participated in the preparation and review of the draft guideline.

Feedback from external peer reviewers was also obtained. The guidelines were reviewed and approved by the Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee (SPGC) and Board of Directors and all collaborating organizations prior to dissemination.

Recommendations

Major Recommendations

Quality of evidence (I–III) and strength of recommendation (A–C) ratings are defined at the end of the "Major Recommendations" field.

Method of Diagnosing Catheter-associated Asymptomatic Bacteriuria (CA-ASB) and Catheter-associated Urinary Tract Infection (CA-UTI)

  1. CA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source of infection along with ≥103 colony forming units (cfu)/mL of ≥1 bacterial species in a single catheter urine specimen or in a midstream voided urine specimen from a patient whose urethral, suprapubic, or condom catheter has been removed within the previous 48 hours (A-III).
    1. Data are insufficient to recommend a specific quantitative count for defining CA-UTI in symptomatic men when specimens are collected by condom catheter.
  1. CA-ASB should not be screened for except in research studies evaluating interventions designed to reduce the incidence of CA-ASB or CA-UTI (A-III) and in selected clinical situations, such as in pregnant women (A-III).
    1. CA-ASB in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of ≥105 cfu/mL of ≥1 bacterial species in a single catheter urine specimen in a patient without symptoms compatible with UTI (A-III).
    2. CA-ASB in a man with a condom catheter is defined by the presence of ≥105 cfu/mL of ≥1 bacterial species in a single urine specimen from a freshly applied condom catheter in a patient without symptoms compatible with UTI (A-II).
  1. Signs and symptoms compatible with CA-UTI include new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain; costovertebral angle tenderness; acute hematuria; pelvic discomfort; and in those whose catheters have been removed, dysuria, urgent or frequent urination, or suprapubic pain or tenderness (A-III).
    1. In patients with spinal cord injury, increased spasticity, autonomic dysreflexia, or sense of unease are also compatible with CA-UTI (A-III).
  1. In the catheterized patient, pyuria is not diagnostic of CA-bacteriuria or CA-UTI (AII).
    1. The presence, absence, or degree of pyuria should not be used to differentiate CA-ASB from CA-UTI (A-II).
    2. Pyuria accompanying CA-ASB should not be interpreted as an indication for antimicrobial treatment (A-II).
    3. The absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI (A-III).
  1. In the catheterized patient, the presence or absence of odorous or cloudy urine alone should not be used to differentiate CA-ASB from CA-UTI or as an indication for urine culture or antimicrobial therapy (A-III).

Reduction of Inappropriate Urinary Catheter Insertion and Duration

Limiting Unnecessary Catheterization

  1. Indwelling catheters should be placed only when they are indicated (A-III).
    1. Indwelling urinary catheters should not be used for the management of urinary incontinence (A-III). In exceptional cases, when all other approaches to management of incontinence have not been effective, it may be considered at patient request.
  1. Institutions should develop a list of appropriate indications for inserting indwelling urinary catheters, educate staff about such indications, and periodically assess adherence to the institution-specific guidelines (A-III).
  2. Institutions should require a physician's order in the chart before an indwelling catheter is placed (A-III).
  3. Institutions should consider use of portable bladder scanners to determine whether catheterization is necessary for postoperative patients (B-II).

Discontinuation of Catheter

  1. Indwelling catheters should be removed as soon as they are no longer required to reduce the risk of CA-bacteriuria (A-I) and CA-UTI (A-II).
  2. Institutions should consider nurse-based or electronic physician reminder systems to reduce inappropriate urinary catheterization (A-II) and CA-UTI (A-II).
  3. Institutions should consider automatic stop-orders to reduce inappropriate urinary catheterization (B-I).

Strategies to Consider Prior to Catheter Insertion

Infection Prevention

  1. Hospitals and long term care facilities (LTCFs) should develop, maintain, and promulgate policies and procedures for recommended catheter insertion indications, insertion and maintenance techniques, discontinuation strategies, and replacement indications (A-III).
    1. Strategies should include education and training of staff relevant to these policies and procedures (A-III).
  1. Institutions may consider feedback of CA-bacteriuria rates to nurses and physicians on a regular basis to reduce the risk of CA-bacteriuria (C-II).
    1. Data are insufficient to make a recommendation as to whether such an intervention might reduce the risk of CA-UTI.
  1. Data are insufficient to make a recommendation as to whether institutions should place patients with indwelling urinary catheters in different rooms from other patients who have indwelling urinary catheters or other invasive devices to reduce the risk of CA-bacteriuria or CA-UTI.

Alternatives to Indwelling Urethral Catheterization

  1. In men for whom a urinary catheter is indicated and who have minimal postvoid residual urine, condom catheterization should be considered as an alternative to short-term (A-II) and long-term (B-II) indwelling catheterization to reduce CA-bacteriuria in those who are not cognitively impaired.
    1. Data are insufficient to make a recommendation as to whether condom catheterization is preferable to short-term or long-term indwelling urethral catheterization for reduction of CA-UTI.
    2. Data are insufficient to make a recommendation as to whether condom catheterization is preferable to short-term or long-term indwelling urethral catheterization for reduction of CA-bacteriuria in those who are cognitively impaired.
  1. Intermittent catheterization should be considered as an alternative to short-term (C-I) or long-term (A-III) indwelling urethral catheterization to reduce CA-bacteriuria and an alternative to short-term (C-III) or long-term (A-III) indwelling urethral catheterization to reduce CA-UTI.
  2. Suprapubic catheterization may be considered as an alternative to short-term indwelling urethral catheterization to reduce CA-bacteriuria (B-I) and CA-UTI (C-III).
    1. Data are insufficient to make a recommendation as to whether suprapubic catheterization is preferable to long-term indwelling urethral catheterization for reduction of CA-bacteriuria or CA-UTI.
    2. Data are insufficient to make a recommendation as to whether intermittent catheterization is preferable to suprapubic catheterization for reduction of CA-bacteriuria or CA-UTI.

Intermittent Catheterization Technique

  1. Clean (nonsterile) rather than sterile technique may be considered in outpatient (A-III) and institutional (B-I) settings with no difference in risk of CA-bacteriuria or CA-UTI.
  2. Multiple-use catheters may be considered instead of sterile single-use catheters in outpatient (B-III) and institutional (C-I) settings with no difference in risk of CA-bacteriuria or CA-UTI.
  3. Data are insufficient to make a recommendation as to whether one method of cleaning multiple-use catheters is superior to another.
  4. Hydrophilic catheters are not recommended for routine use to reduce the risk of CA-bacteriuria (B-II) or CA-UTI (B-II).
  5. Data are insufficient to make recommendations on whether use of portable bladder scanners or "no-touch" technique reduces the risk of CA-UTI, compared with standard care.

Insertion Technique for Indwelling Urethral Catheter

  1. Indwelling urethral catheters should be inserted using aseptic technique and sterile equipment (B-III).

Prevention Strategies to Consider After Catheter Insertion

Closed Catheter System

  1. A closed catheter drainage system, with ports in the distal catheter for needle aspiration of urine, should be used to reduce CA-bacteriuria (A-II) and CA-UTI (A-III) in patients with short-term indwelling urethral or suprapubic catheters and to reduce CA-bacteriuria (A-III) and CA-UTI (A-III) in patients with long-term indwelling urethral or suprapubic catheters.
    1. Institution-specific strategies should be developed to ensure that disconnection of the catheter junction is minimized (A-III) and that the drainage bag and connecting tube are always kept below the level of the bladder (A-III).
  1. Use of a preconnected system (catheter preattached to the tubing of a closed drainage bag) may be considered to reduce CA-bacteriuria (C-II).
    1. Data are insufficient to make a recommendation as to whether such a system reduces CA-UTI.
  1. Use of a complex closed drainage system or application of tape at the catheter-drainage tubing junction after catheter insertion is not recommended to reduce CA-bacteriuria (A-I) or CA-UTI (A-III).

Antimicrobial Coated Catheters

  1. In patients with short-term indwelling urethral catheterization, antimicrobial (silver alloy or antibiotic)–coated urinary catheters may be considered to reduce or delay the onset of CA-bacteriuria (B-II).
    1. Data are insufficient to make a recommendation about whether use of such catheters reduces CA-UTI in patients with short-term indwelling urethral catheterization.
    2. Data are insufficient to make a recommendation as to whether use of such catheters reduces CA-bacteriuria or CA-UTI in patients with long-term catheterization.

Prophylaxis with Systemic Antimicrobials

  1. Systemic antimicrobial prophylaxis should not be routinely used in patients with short-term (A-III) or long-term (A-II) catheterization, including patients who undergo surgical procedures, to reduce CA-bacteriuria or CA-UTI because of concern about selection of antimicrobial resistance.

Prophylaxis with Methenamine Salts

  1. Methenamine salts should not be used routinely to reduce CA-bacteriuria or CA-UTI in patients with long-term intermittent (A-II) or long-term indwelling urethral or suprapubic (A-III) catheterization.
    1. Data are insufficient to make a recommendation about the use of methenamine salts to reduce CA-UTI in patients with condom catheterization.
  1. Methenamine salts may be considered for the reduction of CA-bacteriuria and CA-UTI in patients after gynecologic surgery who are catheterized for no more than 1 week (C-I). It is reasonable to assume that a similar effect would be seen after other types of surgical procedures.
    1. Data are insufficient to make recommendations about whether one methenamine salt is superior to another.
  1. When using a methenamine salt to reduce CA-UTI, the urinary pH should be maintained below 6.0 (B-III).
    1. Data are insufficient to recommend how best to achieve a low urinary pH.

Prophylaxis with Cranberry Products

  1. Cranberry products should not be used routinely to reduce CA-bacteriuria or CA-UTI in patients with neurogenic bladders managed with intermittent or indwelling catheterization (A-II).
    1. Data are insufficient to make a recommendation on the use of cranberry products to reduce CA-bacteriuria or CA-UTI in other groups of catheterized patients, including those using condom catheters.

Enhanced Meatal Care

  1. Daily meatal cleansing with povidone-iodine solution, silver sulfadiazine, polyantibiotic ointment or cream, or green soap and water is not recommended for routine use in men or women with indwelling urethral catheters to reduce CA-bacteriuria (A-I).
    1. Data are insufficient to make a recommendation as to whether meatal cleansing reduces the risk of CA-UTI.

Catheter Irrigation

  1. Catheter irrigation with antimicrobials should not be used routinely to reduce or eradicate CA-bacteriuria (A-I) or CA-UTI (A-II) in patients with indwelling catheters.
  2. Catheter irrigation with antimicrobials may be considered in selected patients who undergo surgical procedures and short-term catheterization to reduce CA-bacteriuria (C-I).
    1. Data are insufficient to make a recommendation about whether bladder irrigation in such patients reduces CA-UTI.
  1. Catheter irrigation with normal saline should not be used routinely to reduce CA-bacteriuria, CA-UTI, or obstruction in patients with long-term indwelling catheterization (B-II).

Antimicrobials in the Drainage Bag

  1. Routine addition of antimicrobials or antiseptics to the drainage bag of catheterized patients should not be used to reduce CA-bacteriuria (A-I) or CA-UTI (A-I).

Routine Catheter Change

  1. Data are insufficient to make a recommendation as to whether routine catheter change (e.g., every 2–4 weeks) in patients with functional long-term indwelling urethral or suprapubic catheters reduces the risk of CA-ASB or CA-UTI, even in patients who experience repeated early catheter blockage from encrustation.

Prophylactic Antimicrobials at Time of Catheter Removal or Replacement

  1. Prophylactic antimicrobials, given systemically or by bladder irrigation, should not be administered routinely to patients at the time of catheter placement to reduce CA-UTI (A-I) or at the time of catheter removal (B-I) or replacement (A-III) to reduce CA-bacteriuria.
    1. Data are insufficient to make a recommendation as to whether administration of prophylactic antimicrobials to such patients reduces bacteremia.

Screening for and Treatment of CA-ASB in Catheterized Patients to Reduce CA-UTI

  1. Screening for and treatment of CA-ASB are not recommended to reduce subsequent CA-bacteriuria or CA-UTI in patients with short-term (A-II) or long-term (A-I) indwelling urethral catheters.
  2. Screening for and treatment of CA-ASB are not recommended to reduce subsequent CA-bacteriuria or CA-UTI in patients with neurogenic bladders managed with intermittent catheterization (A-II).
  3. Screening for and treatment of CA-ASB are not recommended to reduce subsequent CA-bacteriuria or CA-UTI in other catheterized patients (A-III), except in pregnant women (A-III) and patients who undergo urologic procedures for which visible mucosal bleeding is anticipated (A-III).

Screening for and Treatment of CA-ASB at Catheter Removal to Reduce CA-UTI

  1. Antimicrobial treatment of CA-ASB that persists 48 hours after short-term indwelling catheter removal in women may be considered to reduce the risk of subsequent CA-UTI (C-I).
    1. Data are insufficient, however, to make a recommendation as to whether all women should be uniformly screened for CA-ASB at catheter removal.
    2. Data are insufficient to make a recommendation about screening for or treatment of persistent CA-ASB in men.

Urine Culture and Catheter Replacement Before Treatment

  1. A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI because of the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance (A-III).
  2. If an indwelling catheter has been in place for >2 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced to hasten resolution of symptoms and to reduce the risk of subsequent CA-bacteriuria and CA-UTI (A-I).
    1. The urine culture should be obtained from the freshly placed catheter prior to the initiation of antimicrobial therapy to help guide treatment (A-II).
    2. If use of the catheter can be discontinued, a culture of a voided midstream urine specimen should be obtained prior to the initiation of antimicrobial therapy to help guide treatment (A-III).

Duration of Treatment

  1. Seven days is the recommended duration of antimicrobial treatment for patients with CA-UTI who have prompt resolution of symptoms (A-III), and 10–14 days of treatment is recommended for those with a delayed response (A-III), regardless of whether the patient remains catheterized or not.
    1. A 5-day regimen of levofloxacin may be considered in patients with CA-UTI who are not severely ill (B-III). Data are insufficient to make such a recommendation about other fluoroquinolones.
    2. A 3-day antimicrobial regimen may be considered for women aged ≤65 years who develop CA-UTI without upper urinary tract symptoms after an indwelling catheter has been removed (B-II).

Definitions:

Quality of Evidence

  1. Evidence from >1 properly randomized, controlled trial
  2. Evidence from >1 well-designed clinical trial without randomization, from cohort or case-controlled analytic studies (preferably from >1 center), from multiple time-series studies, or from dramatic results of uncontrolled experiments
  3. Evidence from opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees

Strength of Recommendation

  1. Good evidence to support a recommendation for or against use
  2. Moderate evidence to support a recommendation for or against use
  3. Poor evidence to support a recommendation for or against use
      Clinical Algorithm(s)

      None provided

      Evidence Supporting the Recommendations

      Type of Evidence Supporting the Recommendations

      The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

      Benefits/Harms of Implementing the Guideline Recommendations

      Potential Benefits

      Appropriate diagnosis and management of catheter-associated urinary tract infection

      Potential Harms

      Side effects and toxicity of antimicrobial therapy

      Qualifying Statements

      Qualifying Statements

      It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

      Implementation of the Guideline

      Description of Implementation Strategy

      An implementation strategy was not provided.

      Implementation Tools
      Audit Criteria/Indicators
      Mobile Device Resources
      Pocket Guide/Reference Cards
      For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

      Institute of Medicine (IOM) National Healthcare Quality Report Categories

      IOM Care Need
      Getting Better
      Staying Healthy
      IOM Domain
      Effectiveness
      Patient-centeredness

      Identifying Information and Availability

      Bibliographic Source(s)
      Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE, Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63. [299 references] PubMed External Web Site Policy
      Adaptation

      Not applicable: The guideline was not adapted from another source.

      Date Released
      2010 Mar
      Guideline Developer(s)
      Infectious Diseases Society of America - Medical Specialty Society
      Source(s) of Funding

      Infectious Diseases Society of America (IDSA)

      Guideline Committee

      Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee

      Composition of Group That Authored the Guideline

      Authors: Thomas M. Hooton, Department of Medicine, University of Miami, Miami, Florida; Suzanne F. Bradley, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center and the University of Michigan, Ann Arbor, Michigan; Diana D. Cardenas, Department of Rehabilitation Medicine, University of Miami, Miami, Florida; Richard Colgan, Department of Family and Community Medicine, University of Maryland, Baltimore; Suzanne E. Geerlings, Department of Infectious Diseases, Tropical Medicine, and AIDS, University of Amsterdam, Amsterdam, The Netherlands; James C. Rice, Department of Medicine, University of Texas, Galveston, Present affiliation: Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California; Sanjay Saint, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center and the University of Michigan, Ann Arbor, Michigan; Anthony J. Schaeffer, Department of Urology, Northwestern University, Chicago, Illinois; Paul A. Tambayh, Department of Medicine, National University of Singapore, Singapore; Peter Tenke, Department of Urology, Jahn Ference Del-Pesti Korhaz, Budapest, Hungary; Lindsay E. Nicolle, Departments of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada

      Financial Disclosures/Conflicts of Interest

      All members of the Expert Panel complied with the Infectious Diseases Society of America (IDSA) policy on conflicts of interest, which requires disclosure of any financial or other interest that might be construed as constituting an actual, potential, or apparent conflict. Members of the Expert Panel were provided IDSA's conflict of interest disclosure statement and were asked to identify ties to companies developing products that might be affected by promulgation of the guidelines. Information was requested regarding employment, consultancies, stock ownership, honoraria, research funding, expert testimony, and membership on company advisory committees. The Panel made decisions on a case-by-case basis as to whether an individual's role should be limited as a result of a conflict.

      Potential Conflicts of Interest

      T.M.H. has served as a consultant to Alita Pharmaceuticals.

      D.D.C. has served as a consultant to Coloplast A/S, has received research funding from Coloplast A/C and AstraTech and has received honoraria from Alita Pharmaceuticals.

      A.J.S. has served as a consultant to Pfizer, Novabay Pharmaceuticals, Exoxemis, Alita Pharmaceuticals, American Medical Systems, Monitor Company Group, Propagate Pharma, Hagen/Sinclair Research Recruiting, and Advanstar Communications; has received honoraria from Haymarket Media, CombinatoRx, The Scientific Consulting Group, and the Multidisciplinary Alliance Against Device–Related Infections; and has received other remuneration from the American Society of Microbiology and the American Urological Association.

      S.E.G. has served as a consultant to and received honoraria from Merck, GlaxoSmithKline, Bristol-Myers Squibb, and AstraZeneca.

      S.S. has received honoraria from VHA.

      P.A.T. has received research support from Baxter, Merck, Pfizer, Merlion Pharma, and Interimmune.

      R.C. has served as consultant to Johnson & Johnson.

      L.E.N. has served as a consultant to Pfizer, Johnson & Johnson, and Leo Pharmaceuticals.

      All other authors: no conflicts.

      Guideline Status

      This is the current release of the guideline.

      Guideline Availability

      Electronic copies: Available in Portable Document Format (PDF) from the Infectious Diseases Society of America (IDSA) Web site External Web Site Policy.

      Print copies: Available from Dr. Thomas M. Hooton, 1120 NW 14th St. Ste 114, Clinical Research Bldg, University of Miami Miller School of Medicine, Miami, FL 33136; email: thooton@med.miami.edu.

      Availability of Companion Documents

      The following are available:

      • Cather-associated bacteriuria. Pocket guide. Infectious Diseases Society of America (IDSA); 2010. 8 p. Electronic copies: Available from the IDSA Web site External Web Site Policy.
      • A version of the guideline for mobile devices is available from the IDSA Web site External Web Site Policy.

      In addition, performance measures are available in the original guideline document External Web Site Policy.

      Patient Resources

      None available

      NGC Status

      This summary was completed by ECRI Institute on November 10, 2010. The information was verified by the guideline developer on December 6, 2010. This summary was updated by ECRI Institute on October 25, 2013 following the U.S. Food and Drug Administration advisory on Fluoroquinolone Antibacterial Drugs.

      Copyright Statement

      This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

      Disclaimer

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