Individuals with long-term use of indwelling catheters will invariably be bacteriuric. This bacteriuria is usually polymicrobial and is characterized by serial superinfections, that is, the replacement of existing bacteria by new strains or species.1,2 Morbidity associated with bacteriuria and long-term indwelling catheterization includes formation of bladder stones, local abscesses, and bacteremia,3 the last of which is almost always associated with recent catheter trauma.4 Long-term indwelling catheters undoubtedly contribute to mortality, but their precise influence is poorly defined. In addition, frequent courses of antimicrobials given to individuals with long-term indwelling catheters promote the emergence of increasingly resistant organisms.4,5 Such patients with asymptomatic bacteriuria may then become important reservoirs in institutional outbreaks of infection with multiple resistant organisms.6
Fortunately, there are few situations now in which long-term indwelling catheters are indicated, largely because of widespread acceptance of intermittent catheterization, especially for patients with injuries to the spinal
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