Reducing catheter urinary tract infection risk through biofilm prevention: evidence-based strategies for urinary catheter management

Abstract

Background and Objectives: Catheter-associated urinary tract infections (CAUTIs) are common healthcare-associated infections mainly caused by biofilm formation on urinary catheters. This study aimed to provide evidence-based catheter management strategies to reduce CAUTI risk through biofilm prevention.

Materials and Methods: This prospective observational study included 109 adult patients undergoing urinary catheteriza- tion between September 2017 and January 2018. Urine samples were collected after catheter insertion and before catheter removal. Bacteriuria was screened using flow cytometry and confirmed by urine culture. Removed catheters were cultured to assess biofilm formation, while isolates were tested for biofilm-forming ability using Congo Red Agar (CRA).

Results: The mean catheterization duration was 5.6 ± 2.1 days, and most patients were catheterized for ≥5 days. Bacteriuria was significantly associated with catheterization (p = 0.029). Antibiotic use reduced bacteriuria incidence (p < 0.001) but did not significantly reduce biofilm formation (73.4%, p > 0.05). CRA-positive isolates showed 1.5-fold greater biofilm-forming potential. Female sex, early bacteriuria, and catheterization >5 days were associated with biofilm formation.

Conclusion: Urinary catheterization promotes biofilm and increases CAUTI risk. Although antibiotics reduced bacteriuria, they showed limited efficacy against biofilms. Early bacteriuria screening, routine monitoring, biofilm prevention, and limit- ing catheter duration may help reduce CAUTI incidence.