The Role of Urinary Catheters in Development of Nosocomial Urinary Tract-Related Bacteremia

This dissertation examines risk factors for bacteremia secondary to catheter-associated bacteriuria (CAB), specifically the potential risk of continued catheter presence, and assesses the degree to which hospitals in the United States (US) have implemented strategies to reduce unnecessary use of urinary catheters. In Chapter One, the problems of urinary tract-related bacteremia and unnecessary use of urinary catheters are introduced and their significance is described. In Chapter Two, a systematic review of the literature identifying risk factors for bacteremia secondary to CAB among adults in acute care settings is reported. In Chapter Three, a case control study elucidating risk factors for secondary bacteremia among adult patients with nosocomial CAB is reported, including an assessment of the risk posed by the continued presence of a urinary catheter after the onset of CAB. In Chapter Four, the prevalence and predictors of urinary catheter reduction policies in US hospitals is reported. In Chapter Five, findings of the three studies are summarized and overarching conclusions are provided including strengths, limitations, and implications for research, practice, and policy.