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Clinical Microbiology Reviews, January 2008, p. 26-59, Vol. 21, No. 1
0893-8512/08/$08.00+0     doi:10.1128/CMR.00019-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis

S. M. Jacobsen,1 D. J. Stickler,2 H. L. T. Mobley,3 and M. E. Shirtliff1,4*

Department of Microbiology and Immunology, School of Medicine, University of Maryland—Baltimore, 655 W. Baltimore Street, Baltimore, Maryland 21201,1 Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3TL, United Kingdom,2 Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan 48109,3 Department of Biomedical Sciences, Dental School, University of Maryland—Baltimore, 650 W. Baltimore Street, Baltimore, Maryland 212014

Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options.

* Corresponding author. Mailing address: Department of Biomedical Sciences, Dental School, University of Maryland—Baltimore, Room 9209, 650 W. Baltimore Street, Baltimore, MD 21201. Phone: (410) 706-2263. Fax: (410) 706-0865. E-mail: mshirtliff{at}umaryland.edu

Clinical Microbiology Reviews, January 2008, p. 26-59, Vol. 21, No. 1
0893-8512/08/$08.00+0     doi:10.1128/CMR.00019-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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