CAUTI

• Catheter-associated UTI (CAUTI): symptomatic UTI occurring in a patient with an indwelling urinary catheter OR within 48 hours after removal of a urinary catheter

• Catheter-associated asymptomatic bacteriuria (CAASB): bacteriuria (≥ 105CFU/mL) without symptoms in a patient with an indwelling urinary catheter OR within 48 hours after removal of a urinary catheter

CAUTIs are among the most common healthcare-associated infections.

• Microbiology

  • Causative organisms are likely to have antibiotic resistance.

  • In patients with long-term catheterization (≥ 30 days), UTIs are typically polymicrobial.

• Clinical features

  • Infection is commonly asymptomatic or presents with atypical symptoms.

  • Possible symptoms include fever, pelvic or flank pain, hematuria, altered mental status, and lethargy.

  • Catheter obstruction may result from colonization with urease-producing organisms, especially Proteus spp.

A urine culture, ideally obtained prior to antibiotic treatment, is always required to diagnose CAUTI.

• Indications: features consistent with potential infection

• Specimen collection: ideally from the sampling port of a newly inserted device using aseptic technique

• Diagnostic criteria

  • Significant bacteriuria thresholds in catheterized patients [16]

    • CAASB: ≥ 105CFU/mL without symptoms

    • CAUTI: ≥ 103CFU/mL with symptoms of UTI

  • Pyuria is usually present but is not diagnostic of CAUTI in isolation.

• Catheter removal or replacement

  • Remove if no longer necessary.

  • Replace if still necessary and present for > 2 weeks.

• Antibiotic therapy

  • Guided by culture results and local resistance patterns

  • See “Antibiotic treatment of complicated lower UTIs” and “Empiric antibiotic therapy of complicated pyelonephritis” for potential empiric regimens.

  • Duration: typically 7–14 days depending on the resolution of symptoms