Catheter-related UTI (CAUTI)
Check whether the urinary catheter is still required. If possible, removing the catheter should be the first step in the management of CA-UTI. If the catheter is still needed and has been in place for >2 weeks at the onset of CA-UTI, the catheter should be changed.
When changing catheters in patients with a long-term indwelling urinary catheter, do not offer antibiotic prophylaxis routinely.
Consider antibiotic prophylaxis for catheter change only if the patient has a history of symptomatic UTI following previous catheter changes or if the patient experiences trauma during catheterisation.
If infection is suspected review catheter management, and treat as Uncomplicated/Lower UTI or UTI with Sepsis / Pyelonephritis as clinically appropriate.
Do not treat asymptomatic bacteriuria or “positive” urine dipsticks in the absence of urinary symptoms.
Do not send urine samples for culture in asymptomatic elderly patients, even if dipstick tests are positive.
Do not send urine samples to check for clearance of infection.
Only treat patients with recognised signs or symptoms of CA-UTI. Symptoms of CA-UTI include fever, rigors, flank / costovertebral / suprapubic discomfort, change in voiding patterns, nausea, vomiting, malaise or altered mental status. Smelly urine is not a sign of CA-UTI. Consider prostatitis in catheterised men with perineal pain or a tender prostate.
All long-term indwelling catheters become colonised with bacteria, and even in the absence of symptoms CSUs will be positive, often with two or more organisms (reported as “heavy mixed growth”). Treatment of asymptomatic bacteriuria will not eradicate bacteriuria or prevent symptomatic episodes or reduce mortality, but conversely causes increased short-term frequency of infection and colonisation with antimicrobial-resistant organisms.
Dipstick testing cannot be used to diagnose UTI in catheterised patients as it detects bacteriuria, not infection.
Send a CSU for culture and sensitivities before starting empirical antibiotics. Do not send urine samples for culture in asymptomatic catheterised patients. Specimens should never be obtained from the drainage bag. If the catheter is being replaced, send a urine sample from the new catheter following catheter change.