Risk Factors for Nosocomial Bacteremia Secondary to Urinary Catheter-associated Bacteriuria

A Systematic Review

Laurie J. Conway, RN, MPhil, CIC; Eileen J. Carter, PhD, RN; Elaine L. Larson, PhD, RN, FAAN, CIC


Urol Nurs. 2015;35(4):191-203. 

In This Article

Abstract and Introduction


A systematic appraisal of evidence suggests that male patients in hospital may be at higher risk for bacteremia following urinary catheter-associated bacteriuria than females. Other risk factors include immunosuppressant medication, red blood cell transfusion, neutropenia, malignancy, and liver disease.


Each year, more than 13,000 deaths are attributed to health care-associated urinary tract infections (Klevens et al., 2007). The vast majority of these infections are associated with urinary catheters (Hooton et al., 2010). Bacteriuria is a growth of bacteria in the urine and diagnosed by urine culture. Adult patients with urinary catheters develop bacteriuria at a rate of 8% per day during the first week (Garibaldi, Burke, Dickman, & Smith, 1974). One in 27 hospital patients with catheter-associated bacteriuria (CAB) goes on to develop secondary bacteremia (Saint, 2000) with a seven-day mortality of more than 30% (Melzer & Welch, 2013) and an attributable mortality rate of 12.7% (Bryan & Reynolds, 1984). The cost of bacteremia due to CAB was conservatively estimated at $2,836 per episode in 2000 (Saint, 2000) or approximately $3790 today (Friedman, 2014). The precise link between CAB and bacteremia remains unknown.

Identifying patients with CAB who are likely to progress to bacteremia would enable clinicians to direct interventions, such as early catheter removal, in-out catheterization, or use of condom catheters instead of indwelling urethral catheters to patients at highest risk for the most serious sequelae of CAB (Hooton et al., 2010). We conducted a systematic review to identify risk factors for bacteremia secondary to CAB among adults in acute care settings.