Preventing CAUTI

Tackling Urinary
Tract Infections

Catheter-Associated Urinary Tract Infections (CAUTI) can be extremely virulent bacterial infections which are very difficult to treat and eradicate.

With a 5% cumulative increased risk of bacteriuria per day of a fitted catheter, we can assume that within 1 month of having a catheter a patient has developed some form of a bacterial infection.[1] CAUTIs are the most common cause of gram-negative bacteraemia in hospitalised patients and are responsible for 40% of Hospital-Acquired Infections (HAIs). [2] Biofilms on the indwelling catheter have been shown to be the main cause of CAUTI and can also be responsible for the blocking of catheters. [3]

Recurrent UTIs, can lead to the total cost of episodes per annum across the UK to be greater than £1 billion. [6]

Tackling Biofilms

Biofilms on catheters and prostheses are also the prime source of antibiotic resistance in persistent bacterial infections, which make them incredibly challenging to eliminate with antimicrobial agents. [4] This is because one of the key characteristics of biofilms is the heightened survival to antibiotics and resistance to the immune system of the host; bacteria in biofilms can be up to 1000 times more resistant to antibacterials than bacteria in the planktonic state. Therefore, biofilms provide a survival aid to their residing microorganisms, accounting for the virulent infections which are resistant to antibacterials.

More than 
Patient Stress

The financial burden of catheter UTI’s on the NHS is staggering, with the cost of just one episode at £1,968, in the National Evidence Based Guidelines provided by NICE. [5] Within 2-10 days, 30% of catheterised patients will develop bacteriuria, with 24% of them progressing to develop CAUTI symptoms. CAUTI bacteraemia is responsible for a 13-33% mortality rate so it’s incredibly important the infections don’t reach this stage. The cost of one catheter UTI episode gives an approximate blended cost of £4,600 per annum for patients with recurrent UTIs, although this value can be much higher, leading the total cost of episodes per annum across the UK to be greater than £1 billion. [6] CAUTIs are incredibly costly, for example extending the length of hospital stay by 6 days, with around 43-56% of all UTIs being associated with indwelling catheters. This further demonstrates the importance of finding a solution, especially with the financial burden to the NHS of £150 million from HIAs.[7]

shu-Bacteria

‘A healthcare associated Gram-negative BSI is a positive blood culture for a Gram-negative pathogen in patients who received healthcare in the community or hospital in the previous 28 days’ (Public Health England)

E. coli BSI

Escherichia coli Bloodstream Infections (BSIs) are a major patient safety issue and are set to cost the NHS £2.3 billion by 2018. These contributed to over 5500 NHS patient deaths in 2015 and there is a national initiative which is incentivised to reduce healthcare associated Gram-negative BSIs by 50% across the NHS by 2021. The goals are to:

  • Prevent Gram-negative BSIs
  • Prevent the need for antibacterial prescription
  • To reduce the dose or length or antibiotics as a minimum
  • To reduce hospital admissions and HAIs (Hospital Acquired Infections).

E. coli is one of the main pathogens responsible for causing CAUTI, of which Gram-negative CAUTIs are often a source of bacteraemia. E. coli account for 55% of all BSIs, and of these UTIs are responsible for 45% of E. coli BSIs.

E. coli BSIs have increased by 20% over the last five years and the trend is still increasing, which is of grave concern. Furthermore, preventing BSIs should have a huge impact on reducing antimicrobial prescription, which is a key way of reducing the rise in antibiotic resistance. By preventing the run-up to E. coli BSIs, between £900-2400 can be saved per patient.

If we can prevent these E. coli CAUTIs from forming in the first instance, we could be on track with this NHS initiative in reducing E. coli BSI rates. In preventing these infections, we can also reduce antibacterial prescription which we know has a direct correlation to antibiotic resistance.

CAUTIs cost the NHS a staggering amount each year, leading to high levels of antibiotic prescribing.

In the growing fight against antibiotic resistance it is key to find novel infection prevention strategies and to dramatically reduce the amount of antibiotics prescribed.

NHS 5 Year Forward Plan

The NHS ‘5 Year Forward Plan’ was devised to set out a clear direction for the NHS, showing why change is needed and how it can be achieved. There are several points in this plan which directly relate to infections prevention, and how this can contribute to an improved NHS.

  1. Nicolle, LE. (2005) Catheter-related urinary tract infection, Drugs & Aging, 22(8), 627-39.

  2. Soto, SM. (2014) Importance of Biofilms in Urinary Tract Infections: New Therapeutic Approaches, Advances in Biology, 2014, 1-13.

  3. Budhu, S., Jacob, H., Kavalus, K., Kothari, K.,Loike, JD., Plitt, A., Ray, Y., Zumeris, J. (2013). Surface Acoustic waves Enhance Neutrophil Killing of Bacteria, PLoS One, 8(8), e68334.

  4. Banin, E., Degtyar, E., Kopel, M. (2011) Surface Acoustic Waves Increase the Susceptibility of Pseudomonas aeruginosa biofilms to antibiotic treatments, Biofouling, 27(7), 701-710.

  5. Bak, A., Browne, J., Golsorkhi, M., Loveday, HP., Pratt, RJ., Prieto, J., Tingle, A., Wilcox, M., Wilson, JA. (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England, Journal of Hospital Infection, 86S1, S1

  6. Feneley, RCL., Hopley, IB, Wells, PNT. (2015) Urinary catheters: history, current status, adverse effects and research agenda, Journal of Medical Engineering and Technology, 39(8), 459-470.

  7. Scott, BM. (2010) Clinical and cost effectiveness of urethral catheterisation: a review, Journal of Perioperative Practice, 20(7), 235-40.