Catheter-associated UTI (CA-UTI)

Definition of CA-UTI:

- catheter urine culture with ≥ 10⁶cfu/L of ≥ 1 organism(s) (infections may be polymicrobial) in a patient with urinary symptoms and/or signs (costovertebral tenderness, rigors) who is currently catheterized (short-term [< 30 days], long-term [≥ 30 days], intermittent) or has been catheterized within previous 48 hours.

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.

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

Prevention:

• Optimal hydration essential.

• Hand hygiene before and after patient care.

• Remove catheter as soon as not needed.

• 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 except prior to catheter removal in patients catheterized for > 48 hours post surgery involving prosthetic material.

• Data inconclusive as to whether routine catheter change is effective in reducing CA-UTI.

• NO convincing evidence for efficacy of antibiotic coated catheters.

Enterobacteriaceae
Enterococcus spp
P. aeruginosa
Coagulase negative Staphylococci

Candida spp

Asymptomatic

Symptomatic

Mild

Alternative

Febrile, systemically unwell

Septic/Hemodynamically unstable