The catheter and urinary tract infection.

Catheter-associated bacteriuria is the most common infection acquired in hospitals and nursing homes. This infection would be even more common but for the use of the closed catheter system. Most modifications have not improved upon the closed catheter itself. However, even with meticulous care, this system will not prevent bacteriuria forever. After bacteriuria develops, our ability to limit its complications is minimal. Additionally, the catheterized urinary tract becomes a reservoir of bacteria that can be transferred to other patients. Once a catheter is put in place, one must keep two important concepts in mind: (1) keep the catheter system closed in order to postpone the onset of bacteriuria; and (2) remove the catheter as soon as possible. If the catheter can be removed before bacteriuria develops, postponement becomes prevention. However, the best prevention is not to use a urethral catheter at all. Non-device alternatives to urethral catheterization should be used whenever possible. If these are not useful or successful, then other devices might be considered. For incontinent men, a condom catheter is a useful alternative. For patients with urinary retention, intermittent or suprapubic catheterization may be options for both short-term and long-term needs. The roles of these alternatives to urethral catheters must be defined by controlled trials.