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About

• A catheter-associated urinary tract infection (UTI) is a symptomatic infection of the bladder or kidneys in a person with a urinary catheter.
• The longer a catheter is in place, the more likely bacteria will be found in the urine; after 1 month nearly all people have bacteriuria.
• Antibiotic treatment is not routinely needed for asymptomatic bacteriuria in people with a catheter.

Clinical

• cloudy urine, blood in the urine, strong urine odour, urine leakage around your catheter pressure
• Pain, or discomfort in your lower back or stomach, chills, fever, unexplained fatigue, vomiting

Investigations

• If the catheter has been changed, obtain the sample from the new catheter.
• If the catheter has been removed, obtain a midstream specimen of urine.
• Send the urine sample for culture and susceptibility testing, noting a suspected catheter-associated infection and an antibiotic prescribed.

Management

• Consider removing or, if this cannot be done, changing the catheter as soon as possible in people with a catheter-associated UTI if it has been in place for more than 7 days. Do not allow catheter removal or change to delay antibiotic treatment.
• Obtain a urine sample before antibiotics are taken. Take the sample from the catheter, via a sampling port if provided, and use an aseptic technique (in line with the NICE guideline on healthcare-associated infections).
• Offer an antibiotic (see the recommendations on choice of antibiotic) to people with catheter-associated UTI. Take account of:

Choosing antibiotic consider

• the severity of symptoms
• the risk of developing complications, which is higher in people with a known or suspected structural or functional abnormality of the genitourinary tract, or immunosuppression
• previous urine culture and susceptibility results
• previous antibiotic use, which may have led to resistant bacteria.
• When urine culture and susceptibility results are available: review the choice of antibiotic and change the antibiotic according to susceptibility results if the bacteria are resistant, using narrow-spectrum antibiotics wherever possible.
• When an antibiotic is given, as well as the general advice on self-care, give advice about: possible adverse effects of antibiotics, particularly diarrhoea and nausea seeking medical help if: symptoms worsen at any time or symptoms do not start to improve within 48 hours of taking the antibiotic or the person becomes systemically very unwell.

Refer people with catheter-associated UTI to hospital

• Symptoms or signs suggesting a more serious illness or condition (for example, sepsis).
• Significantly dehydrated or unable to take oral fluids and medicines
• Pregnant
• Higher risk of developing complications (for example, people with known or suspected structural or functional abnormality of the genitourinary tract, or underlying disease [such as diabetes or immunosuppression]) or
• Recurrent catheter-associated UTIs or have bacteria that are resistant to oral antibiotics

Simple UTI Adult non pregnant

• Nitrofurantoin if eGFR =45 ml/minute 100 mg modified-release twice a day (or if unavailable 50 mg four times a day) for 7 days
• Trimethoprim if low risk of resistance 200 mg twice a day for 7 days
• Amoxicillin (only if culture results available and susceptible) 500 mg three times a day for 7 days

IV Antibiotics: Sepsis vomiting

• Co-Amoxiclav (only if culture results available and susceptible) 500/125 mg three times a day for 7 to 10 days
• Trimethoprim (only if culture results available and susceptible) 200 mg twice a day for 14 days
• Ciprofloxacin (consider safety issues) 500 mg twice a day for 7 days
• Gentamicin Initially 5 to 7 mg/kg once a day, subsequent doses adjusted according to serum Gentamicin concentration
• Amikacin Initially 15 mg/kg once a day (maximum per dose 1.5 g once a day), subsequent doses adjusted according to serum amikacin concentration (maximum 15 g per course)

Pregnant

• First-choice oral antibiotic: Cefalexin 500 mg BDS/TDS (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days
• First-choice IV antibiotic (if vomiting, unable to take oral antibiotics, or severely unwell) Cefuroxime 750 mg to 1.5 g three or four times a day

References

• NICE guidance

Revisions