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The clinical picture fits with an upper urinary tract infection. A catheter sample of urine shows protein ++, Leucocytes ++ and nitrites++. You send a sample for culture.

• IV fluids preferably Crystalloid to replace the deficit
• Obtain a urine sample from the sampling port of the catheter using an aseptic technique (in line with the NICE guideline on healthcare-associated infection) and send for culture and susceptibility testing.
• Consider removing or changing the catheter before treating the infection if it has been in place for more than 7 days. Catheters should be removed rather than changed where possible
• Antibiotics e.g. stat dose of Gentamicin 5 mg/kg and then Co-Amoxiclav 625 mg TDS PO for 7 days

Refer people with catheter-associated UTI to the hospital if they have a severe systemic infection (any of the high-risk criteria from the NICE guideline on sepsis).

Generally unhelpful. The only time that it might be useful is in pregnant patients. In older patients with catheters, the dipstick can appear positive but treatment only advised when there are symptoms or signs of UTI.

• Those who are 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]
• Those with recurrent catheter-associated UTIs.

• Co-Amoxiclav 625 mg three times a day for 7 days
• Ciprofloxacin 500 mg twice a day for 7 days
• Levofloxacin 500 mg once a day for 7 days
• Trimethoprim (only if culture results available and susceptible) 200 mg twice a day for 14 days

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