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A conundrum of #catheter coatings and #CAUTI

The distal urethra is a residency for #bacteria, mostly commensals, but sometimes potential uropathogens move in.

#Catheterisation hygiene cleans the skin around the urethral meatus but does not remove bacteria residing in the distal urethra.

Many people have focused time, effort and money on coatings that are supposed to prevent such bacteria surviving #catheter entry into the #bladder. Such a #coating would need to kill the potential pathogens before they are transferred from the distal urethra into the bladder, a journey in women of about 4 cm, so typically no longer than a few seconds. In men, clearly the extra distance would add only a further few seconds to the journey. Once in the bladder, the #bacteria simply could swim-off.

Does anyone believe bacterial killing is achievable in that time frame, let alone with a catheter coating that would be safe for urethral and bladder #urothelium? I don’t.

Does any clinician have sufficient confidence in such prophylaxis methodology to spend extra money on #antimicrobial-coated #catheters? When cystitis arises with them, should we blame poor hygiene and send the patients back for another lesson in #catheterisation #hygiene or would that be just another example of blaming “carpenters instead of their tools?”

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