Nosocomial urinary tract infections in intensive care units

The purpose of this review was to analyze literature concerning the diagnostic, prevention, and management of nosocomial urinary tract infection (NUTI) in intensive care unit (ICU) patients harboring a urinary catheter. Analysis was performed from personal and "Pubmed" data, using the following keywords: "urinary tract infection" and "intensive care unit". A lot of expert advice and reviews were found but few clinical trials concerning ICU patients. There was no consensus of the use of urinary reagent tests for the diagnosis. Its usefulness was recommended by one study defining bacteriuria as the presence of 10(5) bacteria mL(-1). The prevention of UTI in ICU was not extensively assessed. One prospective, non randomized study showed the uselessness of complex close drainage systems to prevent bacteriuria. One prospective and randomized study proved the lack of effectiveness of silver-coated urinary catheters, compared to standard catheters. Bladder irrigation was responsible for an increase in multiresistant bacteria. Antimicrobial treatment should not be administrated in prophylaxis. The management of catheter-associated UTIS in ICU patients has not been evaluated in clinical trials. Only one study suggested a systemic treatment in patients with candiduria. The level of evidence given by this data is weak and shows the need to make randomized studies in the field of catheter-associated UTIS in ICU patients. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.