Información del artículo
La prevalencia de pacientes con sonda urinaria en el ámbito comunitario se ha cifrado entre el 0,02 y el 0,07%. A pesar del empleo sistemático de sistemas cerrados, el riesgo de bacteriuria tras la colocación de un catéter uretral oscila entre el 3 y el 10% por día, y su aparición es universal cuando la cateterización se prolonga durante 30 o más días. Aunque la mayor parte de estos episodios de bacteriuria son asintomáticos, hasta un 30% determinan síntomas clínicos y complicaciones, incluidas la sepsis grave y la muerte. Los organismos que infectan la orina de pacientes sometidos a cateterización uretral pertenecen con frecuencia a especies con menor sensibilidad a los antibióticos y constituyen biopelículas en ambas superficies del dispositivo así como, probablemente también, en el urotelio. La formación de biopelículas dificulta enormemente la erradicación con antibióticos de los microbios implicados, favorece posiblemente el desarrollo de resistencia y constituye en determinadas circunstancias el sustrato sobre el que se producen precipitados cristalinos que acaban obstruyendo la luz del dispositivo. Debido a la escasez de estudios clínicos controlados, existen todavía numerosas lagunas en el conocimiento de aspectos esenciales del manejo clínico del paciente portador de una sonda urinaria en la comunidad. En el presente artículo se revisan la epidemiología, los factores de riesgo, la microbiología, la patogenia, las manifestaciones clínicas, el diagnóstico, la prevención y el tratamiento de las infecciones asociadas al catéter urinario en el ámbito comunitario.
Palabras clave:
Infección urinaria asociada al catéter urinario
Biopelículas
Epidemiología
Diagnóstico
Tratamiento
The prevalence of urinary catheterization in the community ranges from 0.02% to 0.07%. Despite the generalized use of closed systems, the risk of bacteriuria in patients with urethral catheters is 3%-10% per day and its presence is universal when the device remains in place for 30 days or longer. Although most of these episodes of bacteriuria are asymptomatic, up to 30% of them lead to clinical symptoms and complications, including severe sepsis and death. The microorganisms infecting the urine of catheterized patients frequently belong to species less susceptible to antibiotics and form biofilms on both the device's surfaces and probably also on the urothelium. Biofilm formation greatly hampers eradication of the involved flora by antibiotics, probably favors the development of resistance and, in some instances, constitutes the substrate on which crystal precipitates are deposited, eventually resulting in blockage of the catheter lumen. Due to the scarce number of controlled studies, there are still many gaps in our knowledge of important issues concerning the clinical management of patients with indwelling urinary catheters in the community. The present study reviews the epidemiology, risk factors, microbiology, pathogenesis, clinical manifestations, diagnosis, prevention and treatment of catheter-related urinary tract infections in the community setting.
Key words:
Catheter-related urinary tract infections
Biofilms
Epidemiology
Diagnosis
Treatment
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