Key Points
- Catheter-associated (CA)-bacteriuria is the most common healthcare-associated infection in hospitals and long-term care facilities worldwide.
- Many episodes of CA-bacteriuria are preventable.
- The most effective way to reduce CA-ASB and CA-UTI is to reduce urinary catheterization by restricting use to patients who have clear indications and by removing the catheter as soon as it is no longer needed.
Table 1. Acceptable Indications for Indwelling Urinary Catheter Use
| Clinically significant urinary retention |
|---|
| Temporary relief or longer term drainage if medical therapy is not effective and surgical correction is not indicated. |
| Urinary incontinence |
| For comfort in a terminally ill patient. |
| If less invasive measures (behavioral and pharmacological interventions, incontinence pads) fail and external collecting devices are not an acceptable alternative. |
| Accurate urine output monitoring required |
| Frequent or urgent monitoring needed, such as critically ill patients. |
| Patient unable or unwilling to collect urine |
| During prolonged surgical procedures with general or spinal anesthesia. |
| Selected urological and gynecological procedures in the perioperative period. |
Definitions and Diagnosis
- CA-ASB in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of ≥ 105 cfu/mL of ≥ 1 bacterial species in a single catheter urine specimen in a patient without symptoms compatible with UTI (A-III).
- CA-ASB in a man with a condom catheter is defined by the presence of ≥ 105 cfu/mL of ≥ 1 bacterial species in a single urine specimen from a freshly applied condom catheter in a patient without symptoms compatible with UTI (A-II).
- CA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source along with ≥ 103 cfu/mL of ≥ 1 bacterial species in a single catheter urine specimen or in a midstream voided urine specimen from a patient whose urethral, suprapubic or condom catheter has been removed within the past 48 hours (A-III).
- Data are insufficient to recommend a specific quantitative count for defining CA-UTI in symptomatic men when specimens are collected by condom catheter.
- Signs and symptoms compatible with CA-UTI include new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute hematuria, pelvic discomfort and, in those whose catheters have been removed, dysuria, urgency, frequency or suprapubic pain or tenderness (A-III).
- In patients with spinal cord injury, increased spasticity, autonomic dysreflexia or sense of unease are also compatible with CA-UTI (A-III).
- In the catheterized patient, pyuria is NOT diagnostic of CA-bacteriuria or CA-UTI (AII).
- The presence, absence or degree of pyuria should not be used to differentiate CA-ASB from CA-UTI (A-II).
- Pyuria accompanying CA-ASB should NOT be interpreted as an indication for antimicrobial treatment (A-II).
- The absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI (A-III).
- In the catheterized patient, the presence or absence of odorous or cloudy urine alone should NOT be used to differentiate CA-ASB from CA-UTI or as an indication for urine culture or antimicrobial therapy (A-III).
- Screening for CA-ASB should NOT be done except in research studies evaluating interventions designed to reduce CA-ASB or CA-UTI (A-III) and in selected clinical situations such as pregnant women (A-III).
- The term "CA-bacteriuria" is used when no distinction is made between CA-ASB and CA-UTI, but is predominantly CA-ASB.