Catheter-Associated Urinary Tract Infection

GENERAL PRINCIPLES

• Catheter-associated urinary tract infection (CAUTI) is the most common HAI.

• E. coli, other gram-negative Enterobacterales, P. aeruginosa, gram-positives (staphylococci, enterococci), and yeast are commonly isolated from catheterized urine.

• Aseptic technique during insertion of a catheter is of utmost importance for prevention of CAUTI as well as prompt removal of the catheter when no longer needed.

DIAGNOSIS

Clinical Presentation

Fever is the most common symptom. Suprapubic and/or flank pain are helpful localizing symptom, although nonspecific presentations (e.g., altered mental status) are also possible.

Diagnostic Testing

• Urinalysis and urine culture should be performed before starting antibiotics. Diagnosis requires identification of ≥10³ CFU/mL of a single uropathogen or ≥1 species of bacteria in urine cultures obtained from patients with indwelling catheters or from a midstream collection if a catheter has been removed within the past 48 hours.

• Pyuria and bacteriuria occur in all in patients with chronic indwelling catheters and should not be treated in absence of symptoms (unless there are complicating factors, as mentioned previously).

TREATMENT

• Symptomatic CAUTI should be managed with removal or exchange of the catheter and treatment with 7-10 days of antibiotic therapy.

• Candiduria should be treated with catheter removal and should not be treated unless the patient is immunocompromised and at high risk for candidemia.⁵⁹