U.S. Urinary Catheterization & CAUTI Landscape

Correlation Between Catheterization and CAUTI Risk

Urinary catheterization is a common medical procedure used to drain urine from the bladder, especially in critically ill, immobile patients who are undergoing surgery. However, it is also the leading cause of Catheter-associated Urinary Tract Infections (CAUTIs). The procedure creates a direct pathway for bacteria to enter the urinary tract, mainly when indwelling catheters are used for extended periods. The risk of infection increases with the duration of catheterization, and biofilms-bacterial colonies that form on catheter surfaces make these infections more difficult to treat. Improper insertion techniques and poor maintenance further elevate the risk. As a result, while urinary catheters serve essential clinical functions, their use must be carefully managed to prevent CAUTIs, which account for a significant portion of healthcare-associated infections.

A urinary catheter is a long, hollow, partially flexible tube that collects urine from the bladder and leads it to the drainage bag. It is available in various sizes and types and is manufactured from different polymers, mainly silicone and latex rubber, polyvinyl chloride (PVC), and polyurethane. Several clinical scenarios outline indications for catheter use, such as managing urinary retention with or without bladder outlet obstruction, managing immobilized patients, hourly urine output measurements in critically ill patients, and improved patient comfort for end-of-life care.

U.S. Catheter-associated Urinary Tract Infections, 2023

Source: CDC, National and State Healthcare-Associated Infections Progress Report, 2023 

Prevention of CAUTI

In July 2024, the CDC published the clinical safety for preventing CAUTIs, which includes:

Healthcare facilities should follow the 2009 CDC Guideline for Prevention of Catheter-associated Urinary Tract Infections. The guideline emphasizes the proper use, insertion, and maintenance of urinary catheters in different healthcare settings. It also presents effective quality improvement programs that healthcare facilities can use to prevent CAUTIs.

Acute care hospitals must follow Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2022 Update. 

Advancements in Antimicrobial Catheter Technologies

Silver Alloy Hydrogel-Coated Catheters (SAH)

Silver, one of the commonly used antimicrobial agents in medical devices to prevent microbial invasion, has been approved by the FDA for use in UCs. Bardex IC and Dover are the two most used and studied silver Foley catheters. Silver is coated onto both the external and internal surfaces of the catheters and used as an alloy along with gold or platinum, or nanoparticles, and polymers. Clinical studies have focused on SAH catheters reducing CAUTI incidence, particularly among critically ill patients. Combining silver's antimicrobial properties with hydrogel coatings inhibits bacterial growth and biofilm development. ​As per data published by NIH 2023, SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs compared with conventional siliconized latex Foley catheters; however, regular catheter replacement is still necessary.

Superhydrophobic Surfaces

The development of microtopographic superhydrophobic polymer surfaces on catheters has shown promise in preventing bacterial adhesion. These surfaces repel fluids and reduce microbial colonization, thereby decreasing infection risks.

​The 2024 study published in ACS Biomaterials Science & Engineering evaluated four advanced surface coatings, superhydrophilic zwitterionic, liquid-like, liquid-infused, and superhydrophobic, to prevent catheter-associated urinary tract infections and encrustation. Among these, the super hydrophilic zwitterionic coating demonstrated the highest antifouling activity, reducing fibrinogen deposition by 72.3% and bacterial adhesion (Escherichia coli and Staphylococcus aureus) by over 75% compared to uncoated polyvinyl chloride surfaces. This coating also improved surface lubricity, decreasing the dynamic coefficient of friction from 0.63 to 0.35. While the super hydrophilic zwitterionic and hydrophobic liquid-like surfaces showed in retarding crystalline biofilm formation in the presence of Proteus mirabilis, their long-term antifouling efficacy may be compromised due to the proliferation and migration of colonized bacteria, as they do not possess bactericidal properties. These findings highlight the potential of ultralow fouling materials as urinary catheter coatings for preventing CAUTIs. 

Integration of Technology in Infection Prevention

Technological advancements are playing a pivotal role in preventing infections associated with urinary catheterization. Electronic reminder systems, such as the CATH TAG, have been effective in reducing catheterization duration and subsequently decreasing CAUTI incidence by 23%. Additionally, diagnostic tools utilizing artificial intelligence, like flow microimaging, have demonstrated high specificity (96.5%) in rapid UTI diagnosis, potentially reducing unnecessary urine cultures.​

Focus on Neurologic Bladder Dysfunction Patients

Neurologic bladder dysfunction (NBD), or neurogenic bladder, impacts millions of Americans and is often caused by conditions like spinal cord injuries, multiple sclerosis, Parkinson’s disease, strokes, diabetes, and spina bifida. These neurological conditions disrupt normal bladder control, leading to issues such as urinary retention or incontinence. Management of NBD often involves urinary catheterization, particularly for patients who cannot empty their bladders. Clean intermittent catheterization (CIC) is preferred for many mobile patients due to its lower risk of complications than long-term indwelling catheters. However, some individuals may still require indwelling catheters, increasing the risk of catheter-associated urinary tract infections (CAUTIs), a significant concern in acute and long-term care settings in the U.S.

A study published in The BMJ in March 2025 estimates that the number of Parkinson’s disease cases will exceed 25 million by 2050. This projection represents a 112% increase compared to 2021.

Top 5 U.S. States Based on the Death Rate (%) Due to PD, for 2022

Source: CDC