PTU - Polskie Towarzystwo Urologiczne
list of articles:

Bacterial flora of lower urinary tract in men with indwelling catheters in years 1994-1996 and 2004-2006
Article published in Urologia Polska 2008/61/3.


Łukasz Zapała, Bartosz Dybowski, Ewa Bres-Niewada, Anna Sonczyk, Anna Adamska, Andrzej Borkowski
Katedra i Klinika Urologii Warszawskiego Uniwersytetu Medycznego


benign prostatic hyperplasia (BPH) indwelling urinary catheter antibiotic resistance



Persistent indwelling catheters frequently are the source of infections with multidrug resistant strains and perioperative complications.

The aim of the study.

The aim of the study was to compare the bacterial species and the antibiotic resistance of strains isolated from urine of catheterized patients with benign prostatic hyperplasia (BPH) hospitalized in years 1994-1996 and 2004-2006.

Material and methods.

Clinical records and urine cultures performed at admission of patients with BPH and indwelling catheters were analyzed. All the patients hospitalized in our department in years 1994-1996 and 2004-2006 were enrolled.


In years 1994-1996 156 BPH patients with indwelling catheters were hospitalized, and in years 2004-2006 there were 117 patients. Median of catheterization time was 2 and 3 months respectively. Bacteriuria was found in 76.3% and in 83.8% individuals respectively. In the reported period the rate of Gram-positive strains increased from 10% to 25%. Resistance of Gram-negative strains
increased to amoxicilin+clavulanic acid, cefuroxime, amikacin and ciprofloxacin. However, significant decrease of resistance to cotrimoxazol was found. Among Gram-positive strains resistance increased to amoxicilin+clavulanic acid, ciprofloxacin, nitrofurantoin and tetracyclines. In years 2004-2006 98% of Gram-negative strains were susceptible to imipenem and all Gram-positive bacteria were susceptible to vancomycin.


Changes in resistance of catheter-associated flora make indispensable use of combined antimicrobial therapy. It is crucial to improve catheter management and to use antibiotics in permanently catheterized patients responsibly. Rigorous hygienic measures should be implemented in rooms where catheters are replaced. The patients with permanent catheters should be isolated on wards.


  1. Gravel D, Taylor G, Ofner M et al: Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. J Hosp Infect 2007, 66, 243-248.
  2. Stamm WE: Catheter-associated urinary tract infections: epidemiology, pathogenesis and prevention. Am J Med 1991, 91, 65S-71S.
  3. Warren JW: Catheter-associated urinary tract infections. Int J Antimicrob Agents 2001, 17, 299-303.
  4. Yoon H, Choi J, Park Y et al: Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective. Am J Infect Control 2005, 33, 595-601.
  5. U-Syn H, Yong-Hyun C: Catheter-associated urinary tract infections: new aspects of novel urinary catheters. Int J Antimicrob Agents 2006, 28, 485-489.
  6. Wilde MH: Urinary tract infection in people with long-term urinary catheters. J Wound Ostomy Continence Nurs 2003, 30, 314-323.
  7. Trautner BW, Darouiche RO: Role of biofilm in catheter-associated urinary tract infections. Am J Infect Control 2004, 32, 177-183.
  8. Matsukawa M, Kunishima Y, Takahashi S et al: Time courses of bacterial density in urine during antibacterial chemotherapy and influential factors in patients having positive bacteriuria with a complicated urinary tract. J Infect Chemother 2007, 13, 99-104.
  9. Dettenkofer M, Ebner W, Els TJ: Surveillance of nosocomial infections in a neurology intensive care unit. J Neurol 2001, 248, 959-964.
  10. Ena J, Arjona F, Martinez-Peinado C et al: Epidemiology of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Urology 2006, 68, 1169-1174.
  11. Pickard R, Emberton M, Neal DE: The management of men with acute urinary retention. Br J Urol 1998, 81, 712-720.
  12. Hamasuna R, Betsunoh H, Sueyoshi T et al: Bacteria of preoperative urinary tract infections contaminate the surgical fields and develop surgical site infections in urological operations. Int J Urol 2004, 11, 941-947.
  13. Bregenzer T, Frei R, Widmer AF et al: Low risk of bacteremia during catheter replacement in patients with long-term urinary catheters. Arch Intern Med 1997, 157, 521-525.
  14. Raveh D, Rudensky B, Huerta M et al: Use of time-trend analysis in the design of empirical antimicrobial treatment of urinary tract infection. Eur J Clin Microbiol Infect Dis 2003, 22, 158-164.
  15. Warren JW, Tenney JH, Hoopes JM et al: A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982, 146, 719-723.
  16. Wagenlehrer FME, Niemetz A, Naber KG: Erregespekrum und Antibiotikaresistenz beim Harnwegsinfekt und Konsequenzen für die Antibiotiktherapie. Untersuchung bei stationären urologischen Patienten mit Harnwegsinfektionen (1994-2001). Urologe [A] 2003, 42, 13-25.
  17. De Francesco MA, Ravizzola G, Peroni L et al: Urinary tract infections in Brescia, Italy: etiology of uropathogens and antimicrobial resistance of common uropathogens. Med Sci Monit 2007, 13, BR136-44.
  18. Van der Wall E, Verkooyen RP, Mintjes-de Groot J et al: Prophylactic ciprofloxacin for catheter-associated urinary-tract infection. Lancet 1992, 339, 946-951.
  19. Peña C, Albareda JM, Pallares R et al: Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infections. Antimicrob Agents Chemother 1995, 39, 520-524.
  20. Kümmerer K: Resistance in the environment. J Antimicrob Chemother 2004, 54, 311-320.
  21. Ntagiopoulos PG, Paramythiotou E, Antoniadou A et al: Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece. Int J Antimicrob Agents 2007, 30, 360-365.
  22. Dybowski B, Bres-Niewada E, Kryst P i in: Flora bakteryjna u pacjentów z cewnikiem w pęcherzu moczowym utrzymywanym na stałe. Urol Pol 2006, 59, supl. 1, 94.


Łukasz Zapała
Klinika Urologii
ul. Lindleya 4
02-005 Warszawa
tel. (022) 502 17 23