Catheter-associated UTI (CA-UTI)

[Clin Infect Dis 2010;50:625-63, Infect Control Hosp Epidemiol 2014;35:464-79]

Definition of CA-UTI:

- catheter urine culture with ≥ 10⁶ cfu/L of ≥ 1 organism(s) (infections may be polymicrobial) in a patient with urinary symptoms and/or signs (costovertebral tenderness, rigors, new onset delirium, fever (≥38°C), urgency, frequency, dysuria, suprapubic tenderness, pelvic discomfort, hematuria) who is currently catheterized (short-term [< 30 days], long-term [>≥ 30 days]*, intermittent, condom catheters) or has been catheterized within previous 48 hours.

* When a catheter has been in place for >1 week in a long-term catheterized patient who has a symptomatic UTI, the catheter should be changed, and a urine specimen should be obtained through the newly placed catheter before starting antibiotics. Replacement of the catheter results in improved therapeutic outcomes, including decreased duration of fever and decreased likelihood of relapse.

- In patients with spinal cord injury, increased spasticity, autonomic dysreflexia, or sense of unease may indicate CA-UTI.

- 3-7% risk of bacteriuria/day of catheterization; 100% bacteriuria after 30 days

NB: Neither fever nor pyuria are diagnostic for CA-UTI. Do not treat unless evidence of urinary tract symptoms or systemic infection as:

• catheter often colonized with bacteria

• significant risk associated with inappropriate use of antibiotics including development of resistance and Clostridioides (Clostridium) difficile infection.

- Do not send urine culture for blocked catheter or at catheter change.

Prevention:

• Optimal hydration essential.

• Hand hygiene before and after patient care.

• Remove catheter as soon as not needed. Use a reminder system to prompt removal of unnecessary catheters.

• Screening of urine (urinalysis or culture) NOT recommended unless prior to GU surgery/instrumentation.

NB: cloudy/foul smelling urine alone is not an indication for urine culture.

• In catheterized patients, antibiotic prophylaxis is NOT recommended to reduce bacteriuria or UTI.

• Prophylactic antibiotics NOT recommended at time of catheter placement, replacement or removal.

• Routine catheter change is not recommended to reduce CA-UTI.

• NO convincing evidence for efficacy of antibiotic coated catheters.

Enterobacterales
Enterococcus spp
P. aeruginosa
Coagulase negative Staphylococci
Aerococcus urinae
Corynebacterium urealyticum
Candida spp

Asymptomatic

Symptomatic

Febrile, systemically unwell

Septic/Hemodynamically unstable