[Infections associated with the use of indwelling urinary catheters. Infections related to intrauterine devices].

Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.