From the Guidelines
Asymptomatic catheter-associated urinary tract infections (CA-UTIs) in men should not be treated with antibiotics, as the benefits are uncertain and there is high-quality evidence of harm, including adverse effects and increasing the risk of antimicrobial-resistant infections. The 2019 clinical practice guideline for the management of asymptomatic bacteriuria by the Infectious Diseases Society of America makes a strong recommendation against treatment due to the very low certainty of any benefit and high-quality evidence of harm 1.
Key points to consider include:
- The presence of bacteria in catheterized patients is extremely common and often represents colonization rather than infection
- Antibiotics typically fail to sterilize the urine while the catheter remains in place due to biofilm formation on the catheter surface that protects bacteria from antimicrobial agents
- Treatment of asymptomatic bacteriuria in patients with long-term indwelling catheters has been shown to be followed by rapid emergence of antimicrobial resistance in urinary strains 1
- A prospective, randomized comparative trial found no differences between treated and untreated groups in the incidence or prevalence of bacteriuria, number of bacterial strains isolated, incidence of febrile days, or incidence of catheter obstruction 1
In general, the approach to managing asymptomatic CA-UTIs in men should focus on removing or changing the catheter if possible, rather than administering antibiotics. Antibiotic therapy should be reserved for exceptional cases, such as before urologic procedures where mucosal bleeding is anticipated, or in certain immunocompromised patients, and should be guided by urine culture and susceptibility results 1.
From the Research
Asymptomatic Catheter-Associated UTI Treatment in Men
- The treatment of asymptomatic catheter-associated urinary tract infections (CAUTIs) in men is a topic of debate, with various studies providing insights into the management of such cases.
- According to 2, most authorities conclude that antibiotics are not useful for prevention of bacteriuria, nor for treatment of bacteriuria in the asymptomatic catheterized patient.
- The study 3 emphasizes the importance of minimizing indwelling device usage and stopping the catheter as soon as medically possible to prevent bacteriuria and infection.
- A systematic review 4 found that the evidence for systemic prophylaxis instead of when clinically indicated is still equivocal, and antibiotic-impregnated catheters reduce the risk of symptomatic CA-UTIs and bacteriuria.
- Another study 5 highlights the need to rule out predisposing uropathogenic conditions and the use of various drugs, behavioral, and supportive treatment options to minimize UTI recurrence.
- A population-based cohort study 6 evaluated the impact of antibiotic selection and duration of therapy on treatment failure in older adults with CA-UTI, finding that fluoroquinolones and treatment durations ≥ 5 days may be associated with modestly improved clinical outcomes.
Considerations for Treatment
- The decision to treat asymptomatic CAUTIs in men should be based on individual patient factors, such as the presence of underlying medical conditions or the risk of developing complications.
- The use of antibiotics should be judicious, taking into account the potential risks of antibiotic resistance and side effects.
- Alternative approaches, such as removing the catheter as soon as possible or using antibiotic-impregnated catheters, may be considered to reduce the risk of CA-UTIs.
- Further research is needed to determine the optimal management strategy for asymptomatic CAUTIs in men, considering the complexities of individual patient factors and the potential consequences of treatment.