Recent insights into catheter-related urinary tract infections
Urinary tract infections (UTIs) commonly develop in people with urinary catheters. Inserting a catheter can damage the urothelial barrier and trigger the formation of a biofilm on the catheter that allows bacteria direct access to the bladder. Biofilms also protect bacteria from the immune system and reduce antibiotic effectiveness. In addition, a growing literature suggests that the urinary tract harbours bacteria even in people with negative conventional cultures. The urinary microbiome is highly individual. Nevertheless, changes in the urinary microbiome may identify individuals at risk of UTIs and, for example, suggest that a catheter should be replaced more frequently and, in turn, avoid the need for antibiotics. This article outlines the importance of biofilms in the development of catheter-related UTIs and introduces the urinary microbiome.
Regular micturition, the physical barrier provided by urothelial cells and mucin, and the immune system usually prevent bacteria from colonising the urethra and, in turn, the bladder (Gaston et al, 2021). Catheterisation can undermine these defences and may lead to urinary tract infections (UTIs) (Gaston et al, 2021). On average, between 3–10% of people with a catheter develop bacteriuria each day (Shuman and Chenoweth, 2018). Biofilms are central to the development of catheter-related UTIs.
Inserting a catheter can damage the urothelial barrier and trigger immune responses. As a result, the patient may deposit proteins (eg fibrinogen) onto the catheter surface (Gaston et al, 2021). Moreover, inserting a catheter can disrupt micturition. Therefore, patients may retain urine in the bladder, which facilitates microbial growth (Gaston et al, 2021). The flow of warm urine, which is nutrient rich, means that free-floating bacteria attach to the catheter aided by the protein deposited on the tube's surface (Azevedo et al, 2014; 2017; Gaston et al, 2021).
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