Automated bladder irrigation for catheter-associated urinary tract infection prevention: A narrative review of a non-antibiotic antimicrobial stewardship strategy.

Catheter-associated urinary tract infections (CAUTIs) remain a major contributor to healthcare-associated infections and antimicrobial resistance, compounded by diagnostic uncertainty that drives overtreatment of asymptomatic bacteriuria. Current passive prevention strategies have reached a plateau, leaving patients requiring prolonged catheterisation vulnerable to early biofilm formation. Historical irrigation approaches have largely failed because they target mature biofilms rather than the early formation phase (days 1-5). These approaches rely on manual techniques prone to contamination, poor standardisation, and high operational burden. Automated bladder irrigation is proposed to address these limitations through programmable early-phase intervention, closed-system sterility, and reduced dependence on healthcare worker handling. As a non-antibiotic approach, it may support infection prevention and antimicrobial stewardship by reducing CAUTI incidence and minimising diagnostic ambiguity that leads to inappropriate antimicrobial use. Therefore, effective CAUTI prevention requires a shift from passive catheter stewardship to active, biofilm-informed bladder management that addresses both infection control and antimicrobial resistance.