Preventing CAUTI :The role of female
external urinary catheter (FEUC)

Fortunately, CAUTIs are highly preventable with the right strategies. The primary risk factor for CAUTI is prolonged catheterization, with the risk of infection increasing by 3-7% each day.

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Preventing CAUTI :The role of female external urinary catheter (FEUC)

Jul 17, 2025

Fortunately, CAUTIs are highly preventable with the right strategies. The primary risk factor for CAUTI is prolonged catheterization, with the risk of infection increasing by 3-7% each day.Menú[dsm_menu menu_link_text_color="gcid-9ae412ef-a7ae-42a5-ab5b-f691fccab059"...

CAUTI prevalence in Europe

Jul 17, 2025

CAUTI typically leads to longer hospital stays due to the need for additional treatment, monitoring, and sometimes even complications that require further interventions. Patients with CAUTI often remain hospitalized several extra days compared to those without the infection. These extra days are not merely a statistic—they represent a period during which patients are at increased risk of other complications and have a potentially slower recovery process. With patients staying longer in the hospital due to CAUTI, bed turnover slows down. This directly affects the availability of beds for new admissions, leading to longer waiting times for elective surgeries, emergency admissions, and other hospital services. And hospitals must allocate more resources to manage existing patients, potentially leading to bottlenecks in patient flow and delayed care for incoming patients, increasing direct healthcare but also have a ripple effect on hospital efficiency and service delivery. Multiple sources indicate an excess LOS on the order of 2–4 days for patients who develop a CAUTI16.

Historically, studies often cited an additional cost of around €800–€1,000 per CAUTI. For example, a UK analysis (NHS, 2016/17) estimated about £532 (≈€600) in extra hospital cost for each catheter-related UTI17. Similarly, a German study estimated ≈€1,000 in added cost per nosocomial UTI (based on mid-2000s data)18. These figures reflect the incremental resources (medications, lab tests, 1–2 extra days of stay, etc.) attributable to an average CAUTI case.

If the estimated UTIs per year in acute care hospitals in the EU/EEA amounts to 769 336, 62% relates to the use of a urinary catheter (CAUTI) and the average incremental cost per each CAUTI is ≈€1,000 the total cost in the EU/EEA from CAUTI amounts to approximately ≈€477 million.

In summary, CAUTI represents a significant burden for healthcare systems in terms of patient safety, incremental costs, incremental length of stay (longer waiting times) and antimicrobial use (AMR). The estimated annual cost of CAUTIs in Europe amounts to, ≈€477. These figures underscore that catheter-associated CAUTIs represent a significant and preventable burden across European healthcare.

General wards: Elderly patients with multiple morbidities represent a particularly vulnerable group when it comes to the use of urinary catheters in general wards. Most of general wards patients are elder patients with Chronic heart failure (CHF) , kidney failures and respiratory tract infections.

Chronic heart failure (CHF) is the leading cause of hospitalization for those over the age of 65. Its prevalence increase10 fold from age 60 to age 807 and 50% of patients with CHF are over 75 years of age8 .About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF9.CHF is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. Occurrence of HF increases with advancing age, and women at older age are at greater risk than men for CHP with preserved ejection fraction10.

Urinary catheterization is commonly used in CHF patients. It facilitates urine output monitoring, which has theoretical benefits in the management of CHF patients with acute volume overload and pulmonary edema. Routine urinary catheterization placement, however, has been associated with unintended consequences of less frequent physical examinations by physicians, less face-to-face time between physicians and patients, and increased rates of UTI11. Apart of the risk of CAUTI catheter use may contribute to confusion or delirium in some elderly patients, complicating their recovery. Prolonged catheterization can contribute to skin irritation and breakdown, particularly in patients with fragile, aged skin.

Antimicrobial resistance is a significant problem in Europe. Each year throughout Europe, more than 35,000 people die from infections with bacteria that are resistant to antimicrobials13.
It was estimated that 75% of the total burden of infections with antibiotic-resistant bacteria in Europe was associated with health care14.
One of the highest independent risk factor for antimicrobial use in the ECDC point of prevalence1 study was observed in patients with a urinary catheter. 66,1% of UTIs, in the same study1, were microorganisms enterobacterales, mainly E Coli (32,35%) and klebsiella spp. (19,3%). Resistance to third-generation cephalosporins among Enterobacterales isolates from HAIs was over 40% in seven of 25 countries. Two countries reported over 20% of Enterobacterales isolates resistant to carbapenems with the highest percentages (Romania 42.9% and Greece 40.8%).

Antimicrobial resistance percentages of bacterial species to different antimicrobial groups in some European Countries1

Conclusion

Indwelling catheters are not indicated solely for the management of urinary incontinence. Depending on the clinical context, the preferred approach is to remove the catheter as soon as possible or to switch to intermittent catheterization. However, in selected cases female external urinary catheters may offer a viable alternative. Due to limited research in Europe ESNO should support future research about different possibilities of CAUTI preventions.