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Urinary Catheter associated Urinary Tract InfectionAka: Urinary Catheter associated UTI, UTI associated with Urinary Catheter, Prevention of Urinary Catheter associated UTI, Urinary Catheter Associated Asymptomatic Bacteriuria

See Also
1. Urinary Tract Infection
Pathophysiology: Causative Organisms
1. Pseudomonas
2. Proteus
3. Providencia
4. Enterobacteriaceae
5. Morganella
6. Enterococcus
Prevention of Urinary Catheter associated UTI
1. Catheterize only when absolutely necessary
2. Insert catheter using sterile technique
3. Anchor catheter to prevent urethral traction
  1. Men
    1. Penis over low abdomen
    2. Tape catheter over abdomen
  2. Women
    1. Tape catheter to anteromedial thigh
4. Maintain closed sterile drainage system
5. Caretakers wash hands before and after catheter care
6. Indications for catheter change (avoid routine change)
  1. Monitor time to obstruction
    1. Change just before anticipated catheter obstruction
  2. Change catheter if no flow in 4 to 8 hours
  3. Consider change with symptomatic UTI
7. Indications for Urinalysis and Urine Culture
  1. Symptoms of Urinary Tract Infection prompt evaluation
  2. Routine screening is not indicated
  3. Cloudy of foul smelling urine is not indications
Signs of Urinary Catheter associated UTI
1. See also Urinary Tract Infection
2. Pyelonephritis signs
  1. Fever over 38.3C (100.9F) for over 24 hours
  2. Mental status change
  3. Hypotension
3. Increased urine cloudiness
4. Increased frequency of Urinary Catheter blockage
5. Increased detrusor muscle spasms
Labs: Symptomatic UTI
1. Urine Culture
2. Blood Culture (indicated for suspected bacteremia)
Management: Asymptomatic Bacteriuria (colonization)
1. Colonization occurs in all Urinary Catheter patients
  1. Long-term catheterization: 3-6 weeks
  2. Clean intermittent catheterization: 2-3 months
2. Prophylactic antibiotics are not indicated
3. Consider limiting antibiotics to symptomatic UTI only
4. Periodic screening Urine Culture not indicated
Management: Symptomatic UTI
1. Duration of antibiotic therapy: 5 to 14 days
2. Short-term catheterization (single bacteria)
  1. Trimethoprim Sulfamethoxazole (Septra or Bactrim)
  2. Ciprofloxacin or other Quinolone
  3. Nitrofurantoin (Macrobid)
3. Long-term catheterization (polymicrobial infection)
  1. Noncritical illness
    1. Trimethoprim Sulfamethoxazole (Septra or Bactrim)
    2. Cefuroxime or other second generation antibiotic
  2. Critical illness (two antibiotic regimen)
    1. Antibiotic 1: Ampicillin
    2. Antibiotic 2
      1. Ceftriaxone (Rocephin) or
      2. Cefprozil (Cefzil) or
      3. Ceftazidime (Fortaz) or
      4. Aztreonam (Azactam)
      5. Gentamycin or other Aminoglycoside or
      6. Ciprofloxacin or other Quinolone antibiotic
References
1. Cravens (2000) Am Fam Physician 61(2):369
2. Gilbert (2000) Sanford Guide Antimicrobial, p.25
3. Walsh (1998) Campbell's Urology, Saunders, p. 159-62

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.