[Catheter-associated urinary tract infections: epidemiology and prevention]

Urinary tract infections (UTIs) represent the second most often observed infectious diseases in community, following the respiratory tract infections. In the United States, these infections account for up to 7 million/year of visits, with a mean yearly expense for the related antibiotic treatment that has been estimated in more than one billion dollars. In nosocomial setting, UTIs represent the most frequent diseases, whose incidence equates 40% of nosocomial infections overall considered; about 80% of UTIs is related to urinary catheterization. In the present review, the authors, after a brief introduction about epidemiology, pathogenesis and aetiology of urinary tract infections, consider two particular settings: long term care facilities, where UTIs represent the most often diagnosed and treated infections, and the Intensive Care Units where occurrence of urinary tract infections represents an especially frequent event as well. Patients referred to both these settings are particular, as they undergo, in most cases, to urinary catheterization. After describing the pathogenesis of UTIs related to catheterization, either short- or long term, the authors consider the different currently available catheters, focusing on silver-coated and silver alloy coated (silver, gold, and platinum). With regard to this latter issue, results presented by a number of papers in the literature are reported, where clinical experiences following the use of these urinary catheters are described. In their conclusion, authors suggest the opportunity to increase any prevention strategy able to reduce the incidence of infections related to urinary catheterization and its consequences, as a more rational length and modality of catheterization, in addition to the use of innovative catheters.