Skip to main content Accessibility help
Hostname: page-component-7f7b94f6bd-rpk4r Total loading time: 0.25 Render date: 2022-07-01T06:21:55.734Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents

Published online by Cambridge University Press:  02 January 2015

Philip W. Smith
Health Sciences Centre, Winnipeg, Manitoba, Canada
Lindsay E. Nicolle*
Health Sciences Centre, Winnipeg, Manitoba, Canada
Health Sciences Centre, GC430-820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada


From 5% to 10% of residents of long-term–care facilities have urinary drainage managed with chronic indwelling catheters. These residents are always bacteriuric, usually with a complex microbiological flora of two to five organisms and a biofilm on the catheter that may contribute to obstruction. Residents with chronic indwelling catheters have increased morbidity from urinary infection compared to bacteriuric residents without chronic catheters. The most effective means to prevent infection is limitation of chronic indwelling catheter use. While appropriate catheter care and infection control precautions are recommended in managing these patients, the impact of these practices on the occurrence of urinary infection or prevention of symptomatic episodes has not been evaluated. Symptomatic infection can likely be prevented by attention to catheter care, including early recognition and replacement of obstructed catheters and prevention of catheter trauma. Appropriate use of prophylactic antimicrobial therapy prior to invasive genitourinary procedures is also necessary. Asymptomatic bacteriuria should not be treated. When symptomatic episodes occur, patients should be evaluated clinically and microbiologically and treated with appropriate antimicrobial therapy. Further technological advances in catheter material and urine drainage will be needed to have a substantial impact on the frequency of urinary infection with chronic catheter use.

Topics in Long-Term Care
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1.Warren, JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997;11:609622.CrossRefGoogle ScholarPubMed
2.Kunin, CM, Douthitt, S, Dancing, J, Anderson, J, Moeschberger, M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291301.Google Scholar
3.Warren, JW, Stainberger, L, Hebel, R, Tenney, JH. The prevalence of urethral catheterization in Maryland nursing homes. Arch Intern Med 1989;149:15351537.CrossRefGoogle ScholarPubMed
4.Alvery, S, Shell, CG, Woolley, TW, Berk, SL, Smith, JK. Nosocomial infections in long-term facilities. J Gerontol 1988;43:917.Google Scholar
5.Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719723.CrossRefGoogle ScholarPubMed
6.Breitenbucher, RB. Bacterial changes in the urine samples of patients with long-term indwelling catheters. Arch Intern Med 1984;144:15851588.CrossRefGoogle ScholarPubMed
7.Mobley, HLT, Chippendale, GR, Tenney, JH, Mayrei, ARCrisp, U, Penner, JL, et al. MR/K hemagglutination of Providencia stuartii correlates with adherence to catheters and with persistence in catheter-associated bacteriuria. J Infect Dis 1988;157:264271.CrossRefGoogle ScholarPubMed
8.Bjork, DT, Pelletier, LL, Tight, RR. Urinary tract infections with antibiotic resistant organisms in catheterized nursing home residents. Infect Control 1984;5:173176.CrossRefGoogle Scholar
9.Smith, PW, Seip, CW, Schaefer, SC, Bell-Dixon, C. Microbiologic survey of long term care facilities. Am J Infect Control 2000;28:813.CrossRefGoogle ScholarPubMed
10.Ramsay, JWA, Garnham, AJ, Mulhall, AB, Crow, RA, Bryan, JM, Eardley, I, et al. Biofilms, bacteria, and bladder catheters: a clinical study. British Journal of Urology 1989;64:395398.CrossRefGoogle ScholarPubMed
11.Elvis, AWS, Feneley, RCL. Long-term urethral catheterization and the urine-biomaterial interface. British Journal of Urology 1997;80:15.CrossRefGoogle Scholar
12.Kunin, CM. Blockage of urinary catheters. The role of micro-organisms and constituents of urine on the formation of encrustations. J Clin Epidemiol 1989;42:835842.CrossRefGoogle Scholar
13.Mobley, HLT, Warren, JW. Urease-positive bacteriuria and obstruction of long-term urinary catheters. J Clin Microbiol 1987;25:22162217.Google ScholarPubMed
14.Bergqvist, D, Bronnestam, R, Hedelin, H, Stahl, A. The relevance of urinary sampling methods in patients with indwelling Foley catheters. British Journal of Urology 1980;52:9295.CrossRefGoogle ScholarPubMed
15.Grahn, D, Norman, DC, White, ML, Cantrell, M, Yoshikawa, TT. Validity of urinary catheter specimens for diagnosis of urinary tract infection in the elderly. Arch Intern Med 1985;145:18581860.CrossRefGoogle Scholar
16.Tenney, JH, Warren, JW. Bacteriuria in women with long-term catheters: paired comparison of indwelling and replacement catheters. J Infect Dis 1988;157:199202.CrossRefGoogle ScholarPubMed
17.Warren, JW, Damron, D, Tenney, JH, Hoopes, JM, Deforge, B, Muncie, HL JrFever, bacteremia and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis 1987;155:11511158.CrossRefGoogle ScholarPubMed
18.Orr, P, Nicolle, LE, Duckworth, H, Brunka, J, Kennedy, J, Murray, D, et al. Febrile urinary infection in the institutionalized elderly. Am J Med 1996;100:7177.CrossRefGoogle ScholarPubMed
19.Ouslander, JG, Greengold, B, Chen, S. Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study. J Urol 1987;138:11911195.CrossRefGoogle ScholarPubMed
20.Muncie, HL JrHoopes, JM, Damron, DJ, Tenney, JH, Warren, JW. Once-daily irrigation of long-term urethral catheters with normal saline. Arch Intern Med 1989;149:441443.CrossRefGoogle ScholarPubMed
21.Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long term care facility: a five year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647654.CrossRefGoogle Scholar
22.Warren, JW, Muncie, HL JrHall-Craggs, M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective, clinicopathological study. J Infect Dis 1988;158:13411346.CrossRefGoogle ScholarPubMed
23.Warren, JW, Muncie, HL JrBergguist, EJ, Hoopes, JM. Sequelae and management of urinary infection in the patient requiring chronic catheterization. J Urol 1981;125:18.CrossRefGoogle ScholarPubMed
24.Kunin, CM, Chin, QF, Chambers, S. Morbidity and mortality associated with indwelling urinary catheters in elderly patients in a nursing home—confounding due to the presence of associated diseases. J Am Ger Soc 1987;35:10011006.CrossRefGoogle Scholar
25.Cools, HJM, van der Meer, JWM. Restriction of long-term indwelling urethral catheterization in the elderly. British Journal of Urology 1986;58:683688.CrossRefGoogle ScholarPubMed
26.Hebel, JR, Warren, JW. The use of urethral condom, and suprapubic catheters in aged nursing home patients. J Am Ger Soc 1990;38:777784.CrossRefGoogle Scholar
27.Smith, PW, Rusnak, PG. Infection prevention and control in the long term care facility. SHEA Long-Term–Care Committee and APIC Guidelines Committee. Infect Control Hosp Epidemiol 1997;18:831849.CrossRefGoogle Scholar
28.Tambyah, PA, Maki, DG. The relationship between pyuria and infection in patients with indwelling urinary catheters. Arch Intern Med 2000;160:673682.CrossRefGoogle ScholarPubMed
29.Steward, DK, Wood, GL, Cohen, RL, Smith, JW, Mackowiak, PA. Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long term urinary catheters. Am J Infect Control 1985;13:159160.CrossRefGoogle ScholarPubMed
30.Alling, B, Brandberg, A, Seeberg, S, Svanborg, A. Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients. Scand J Infect Dis 1975;7:201207.CrossRefGoogle ScholarPubMed
31.Warren, JW, Anthony, WC, Hoopes, JM, Muncie, HL JrCephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. JAMA 1982;248:454458.CrossRefGoogle ScholarPubMed
32.Kunin, CM, Chin, QF, Chambers, ST. Formation of encrustations on indwelling urinary catheters in the elderly: comparison of different types of catheter materials in “blockers” and “nonblockers.” J Urol 1987;138:899902.CrossRefGoogle ScholarPubMed
33.Stickler, DJ, Clayton, CL, Harber, MJ, Chawla, JC. Pseudomonas aeruginosa and long-term indwelling bladder catheters. Arch Phys Med Rehab 1988;69:2528.Google ScholarPubMed
34.Martinez-Martinez, L, Pascual, A, del Carmen Conejo, M, Pieabea, L, Perea, EJ. Resistance of Pseudomonas aeruginosa to imipenem induced by eluates from siliconized latex urinary catheters is related to outer membrane protein alterations. Antimicrob Agents Chemother 1999;43:398399.Google ScholarPubMed
35.Cafferkey, MT, Falkiner, FR, Gillespie, WA, Murphy, DM. Antibiotics for the prevention of septicemia in urology. J Antimicrob Chemother 1982;9:471477.CrossRefGoogle ScholarPubMed
36.Jewes, LA, Gillespie, WA, Leadbetter, A, Myers, B, Simpson, RA, Stower, MJ, et al. Bacteriuria and bacteremia in patients with long-term indwelling catheters—a domiciliary study. J Med Microbiol 1988;26:6165.CrossRefGoogle ScholarPubMed
37.Bregenzer, T, Frei, R, Widmer, AF, Seiler, W, Probst, W, Mattarelli, G, et al. Low risk of bacteremia during catheter replacement in patients with long-term urinary catheters. Arch Intern Med 1997;157:521525.CrossRefGoogle ScholarPubMed
38.Raz, R, Schiller, D, Nicolle, LE. Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection. J Urol 2000;164:12541258.CrossRefGoogle ScholarPubMed
39.Nicolle, LE. A practical approach to the management of complicated urinary tract infection. Drugs 1997;53:583592.CrossRefGoogle Scholar
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The Chronic Indwelling Catheter and Urinary Infection in Long-Term–Care Facility Residents
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *