This document discusses catheter-acquired urinary tract infection (CAUTI) prevention. It defines CAUTI and catheter-associated asymptomatic bacteriuria. Reducing inappropriate use of carbapenems and other antibiotics is important to prevent resistant organisms. For patients with possible CAUTI, a thorough assessment including symptoms, urinalysis, and urine culture can help determine if active infection is present and guide appropriate treatment.

1. Cathether Acquired Urinary Tract Infection Prevention
Cathether Acquired Urinary Tract Infection PreventionCathether Acquired Urinary Tract
Infection PreventionIdentify the clinical problem/issue. Formulate perspective considering
the limits of position and otherpoints of view.2. Explore consequences or possible outcomes
using national quality and safety initiatives: (30 points)a. National Patient Safety Goals
(NPSG)b. The Joint Commission (TJC)c. Agency for Healthcare Research and Quality
(AHRQ)d. Institute for Healthcare Improvement (IHI)e. Institute for Safe Medication
Practices (ISMP)f. Quality and Safety Education for Nurses (QSEN)g. ANA Code of Ethicsh.
ANA Scopes of Standards and Practice – Nursingi. Quality Improvement Representative or
Quality Safety Council member from the local hospitalor medical centerj. Other. Must
provide rationale for using other evidence based initiative/article incorporated intothe
project.3. Design innovative strategies or solutions to address the selected problem/issue.
Consider newperspectives and ideas during implementation. Be realistic. (20 points)4.
Evaluate the solution(s), conclusions & related outcomes implemented then provide new
data orinformation to be considered.5. Paper should be at least 3 typed pages, not including
the title and reference page. Including title andreference page, there should be a minimum
of 5 pages.6. Paper follows APA format for title page, in text citations, and reference page.7.
Uses at least 2 scholarly articles for references within the text of paper – within 5 years of
publication.ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSPharmacology
Reducing Carbapenem Exposure: Extended-Spectrum `-Lactamase CatheterAssociated
Urinary Tract Infection Management Shannon Holt, PharmD, BCPS-AQ ID Mollie Grant,
PharmD, BCPS, BCCCP Kelly A. Thompson-Brazill, RN, DNP, ACNP-BC, CCRN-CSC Catheter-
associated urinary tract infections are one of the most common sources of infection,
accounting for up to 40% of health care–associated infections each year in the United States.
Extended-spectrum `-lactamase–producing Enterobacteriaceae are frequent causes of
urinary tract infections in health care settings. Prevalent use of carbapenems has led to the
emergence of carbapenem-resistant Enterobacteriaceae infections, leaving clinicians with
few treatment options. Reducing carbapenem use and investigating alternative options for
low-severity extended-spectrum `-lactamase infections is imperative to prevent more cases
of carbapenem-resistant Enterobacteriaceae. Although carbapenems are the antibiotics of
choice for treating extended-spectrum `-lactamase–producing Enterobacteriaceae catheter-
associated urinary tract infections, carbapenem-sparing regimens may be appropriate for
treating hemodynamically stable patients with low inoculum levels. Moreover, frontline
health care providers can initiate efforts to reduce the development of multidrug-resistant

2. organisms by decresing inappropriate antibiotic use during the treatment of catheter-
associated asymptomatic bacteruria, avoiding unnecessary catheterizations, and avoiding
culturing urine in asymptomatic patients. (Critical Care Nurse. 2017;37[5]:78-84) atheter-
associated urinary tract infections (CAUTIs) are one of the most common sources of
infection, accounting for up to 40% of health care–associated infections (HAIs) each year in
the United States. Approximately 95% of urinary tract infections (UTIs) in critically ill
patients develop in individuals who have a urinary catheter in place.1 Prolonged duration of
catheter placement is the highest risk factor for the development of CAUTI.2 During the
time a urinary catheter remains in place, the device alters the body’s natural defense
mechanisms and facilitates the ability of pathogens to migrate from the perineum into the
bladder.3 Microorganisms commonly C CE 1.0 hour, Pharma 0.5, CERP A This article has
been designated for CE contact hour(s). The evaluation tests your knowledge of the
following objectives: 1. Cathether Acquired Urinary Tract Infection PreventionDescribe the
differences among catheter-associated asymptomatic bacteriuria and uncomplicated and
complicated urinary tract infections. 2. Verbalize 5 best practices for urinary catheter
insertion and maintenance during acute care. 3. List noncarbapenem antibiotics to treat
carbapenem-resistant Enterobacteriaceae in patients with low-severity catheter-associated
urinary tract infection. To complete evaluation for CE contact hour(s) for activity C1752,
visit www.ccnonline.org and click the “CE Articles” button. No CE fee for AACN members.
This activity expires on October 1, 2020. The American Association of Critical-Care Nurses is
an accredited provider of continuing nursing education by the American Nurses
Credentialing Center’s Commission on Accreditation. AACN has been approved as a
provider of continuing education in nursing by the State Boards of Registered Nursing of
California (#01036) and Louisiana (#LSBN12). ©2017 American Association of Critical-
Care Nurses doi: https://doi.org/10.4037/ccn2017648 78 CriticalCareNurse Vol 37, No. 5,
OCTOBER 2017 www.ccnonline.org found in the perineum and gastrointestinal tract, such
as Escherichia coli and other Enterobacteriaceae (Table 1),3 often cause CAUTI. Extended-
spectrum `-lactamase (ESBL)– producing Enterobacteriaceae are frequent causes of UTI in
health care settings.5 The Centers for Disease Control and Prevention cites ESBL-producing
Enterobacteriaceae as a serious health care threat.3 Because these organisms are resistant
to many antibiotics, carbapenems have emerged as the drugs of choice for invasive
infections due to ESBLproducing organisms.6 However, this prevalent use of carbapenems
for more than 10 years has led to the emergence of carbapenem-resistant
Enterobacteriaceae (CRE) infections, leaving clinicians with few treatment options.7
Reducing use of carbapenems and investigating alternative options for low-severity ESBL
infections is imperative to prevent more cases of CRE. In addition to reducing carbapenem
use, a reduction in inappropriate antibiotic prescribing overall is necessary. The Centers for
Disease Control and Prevention has reported that inappropriate antibiotic prescribing
occurs for 30% to 50% of hospitalized patients receiving antibiotics.8,9 Cathether Acquired
Urinary Tract Infection PreventionThis inappropriate use of antibiotics not only leads to
increased risk for the development of resistant organisms but also to adverse events
including Clostridium dif?cile–associated diarrhea.10 The purpose of this article is to
describe the criteria for an active ESBL CAUTI and to examine the evidence regarding the

3. currently available ESBL CAUTI treatment options for patients with active infections.
De?nitions Catheter-associated asymptomatic bacteriuria (CAASB) is de?ned as the
presence of signi?cant bacteria in the Authors Shannon Holt is an assistant professor of
clinical education, Eshelman School of Pharmacy, University of North Carolina at Chapel
Hill, Chapel Hill, North Carolina, and a clinical pharmacist specialist, infectious disease,
Department of Pharmacy, WakeMed Health & Hospitals, Raleigh, North Carolina. Mollie
Grant is a critical care pharmacy specialist, WakeMed Health & Hospitals, Raleigh, North
Carolina. Kelly A. Thompson-Brazill is an assistant professor, Georgetown University School
of Nursing and Health Studies, Washington, DC. Corresponding author: Kelly A. Thompson-
Brazill, RN, DNP, ACNP-BC, CCRN-CSC, FCCM, Georgetown University School of Nursing and
Health Studies, 3700 Reservoir Rd NW, Washington, DC 20057 (email:
kat119@georgetown.edu). To purchase electronic or print reprints, contact the American
Association of CriticalCare Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-
1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, reprints@aacn.org.
www.ccnonline.org Table 1 Enterobacteriaceae involved in catheter-associated urinary
tract infections Enterobacter aerogenes Enterobacter cloacae Escherichia coli Klebsiella
pneumoniae Klebsiella oxytoca Morganella morganii Proteus mirabilis Serratia marcescens
Adapted from Hooton et al2 and Murray PR et al.4 urine culture of a patient without signs
or symptoms of a urinary infection.11 Uncomplicated UTI is de?ned as a symptomatic
bladder infection characterized by frequency, urgency, dysuria, or suprapubic pain in a
woman with a normal genitourinary tract, and is associated with both genetic and
behavioral determinants. A complicated UTI is de?ned in the Infectious Diseases Society of
America guidelines as a symptomatic urinary infection in individuals with functional or
structural abnormalities of the genitourinary tract. Assessing Patients With Bacteriuria
Cathether Acquired Urinary Tract Infection PreventionThe ?rst step toward effective
antimicrobial stewardship is decreasing unnecessary exposure to antibiotics, including
carbapenems. The risk of developing multidrugresistant organisms (MDROs) increases with
the inappropriate treatment of urinary catheter colonization or CAASB. Therefore,
determining if the patient is colonized or actively infected is imperative.2 This
determination may be dif?cult in patients with indwelling urinary catheters. They may not
have the classic UTI symptoms of dysuria, urinary frequency, or urgency. When assessing
for symptoms, include nonspeci?c signs such as new onset of fever, chills, altered mental
status, lethargy, or fatigue. In addition, patients may complain of ?ank or suprapubic pain or
discomfort.2,12 Next, if the patient is symptomatic, a urinalysis and urine culture should be
assessed before administering antibiotics. When reviewing the urinalysis, the presence of
10 or more white blood cells per cubic millimeter is referred to as pyuria. Pyuria indicates
in?ammation in the genitourinary tract.13 Pyuria and the appearance of the urine should
not be used to differentiate between CriticalCareNurse Vol 37, No. 5, OCTOBER 2017 79
CAASB and CAUTI.2 Although the lack of pyuria is helpful for ruling out a CAUTI, this ?nding
should not be used as the only diagnostic tool for this infection. The urine culture is also
important for determining CAUTI, and ideally should be obtained from a freshly placed
urinary catheter.2 However, such timing for the culture is not always feasible in practice.
The 2010 Infectious Diseases Society of America guidelines state signi?cant bacteriuria is

4. present when cultures report 10 000 cfu/mL or more. If the urinary catheter was placed
just before the culture, then lower colony counts may re?ect bladder bacteriuria.2 The
completion of a detailed patient assessment can assist with decreasing inappropriate
carbapenem use and overall antibiotic use. If CAASB is suspected, then ESBL therapy would
not be recommended in most patients. Treatment of CAASB may be considered in women
with catheter-acquired bacteriuria 48 hours after indwelling catheter removal Cathether
Acquired Urinary Tract Infection Prevention