Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects

Abstract

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and cause of secondary bloodstream infections. Despite many advances in diagnosis, prevention and treatment, CAUTI remains a severe healthcare burden, and antibiotic resistance rates are alarmingly high. In this review, current CAUTI management paradigms and challenges are discussed, followed by future prospects as they relate to the diagnosis, prevention, and treatment. Clinical and translational evidence will be evaluated, as will key basic science studies that underlie preventive and therapeutic approaches. Novel diagnostic strategies and treatment decision aids under development will decrease the time to diagnosis and improve antibiotic accuracy and stewardship. These include several classes of biomarkers often coupled with artificial intelligence algorithms, cell-free DNA, and others. New preventive strategies including catheter coatings and materials, vaccination, and bacterial interference are being developed and investigated. The antibiotic pipeline remains insufficient, and new strategies for the identification of new classes of antibiotics, and rational design of small molecule inhibitor alternatives, are under development for CAUTI treatment.

Keywords: bacterial competition; bacterial interference; biofilm; catheter-associated urinary tract infection; chaperone-usher; machine learning.

Figure 1

Current and future approaches in the prevention and treatment of catheter-associated urinary tract infections. Schematic depiction of an indwelling urinary catheter (yellow) with its proximal end within the urinary bladder (Orange). The balloon is shown in blue and the catheter drainage hole in black. Pathogenic bacteria (green) may proliferate in the form of biofilms on the intraluminal and/or extraluminal surface of the catheter, which can in turn seed the bladder for infection. Adhesive pili (type 1 pili, for example) are indicated on the bacterial surfaces. The catheter connection tubing is shown in the bottom left of the figure in cyan, and empties to the drainage bag (not shown). Current prevention and treatment techniques are shown in black and blue text, respectively. Green text indicates potential opportunities for both prevention and treatment. Italicized text indicates approaches that are in development or testing phases. Bacterial interference is shown wherein a nonpathogenic strain of bacteria (Orange) is administered to outcompete uropathogenic bacteria for a common niche such as a catheter or the urinary tract, to reduce the risk of infection.