From the Guidelines
Yes, someone can experience urethral inflammation and swelling during a urinary tract infection (UTI) that could cause them to fail a trial of void if a Foley catheter is removed too early in antibiotic treatment. This occurs because the inflammation from the infection can narrow the urethral passage, making it difficult to urinate normally. The use of a urinary catheter should be discontinued as soon as appropriate, and a 7–14-day regimen is recommended for most patients with catheter-associated urinary tract infection (CA-UTI), regardless of whether the patient remains catheterized or not 1. Typically, it's advisable to continue antibiotic treatment for at least 24-48 hours before attempting catheter removal to allow the antibiotics to reduce inflammation. Common antibiotics for UTIs include levofloxacin (750 mg intravenously or orally once daily for 5 days), which has been shown to have similar clinical success rates and microbiologic eradication rates compared to ciprofloxacin (400 mg intravenously and/or ciprofloxacin 500 mg orally twice daily for 10 days) 1. When removing a catheter, it's essential to monitor the patient's ability to void and measure post-void residual volume, as recommended by guidelines that emphasize the importance of assessing fluid status and urinary retention as part of vital sign assessments 1. If the patient cannot void within 6-8 hours or has a residual volume greater than 100-150ml, recatheterization may be necessary. The underlying mechanism involves bacterial infection triggering an inflammatory response in the urethral tissues, causing edema and potentially spasm of the urethral sphincter, which physically impedes urine flow despite the bladder's attempt to contract and expel urine. Key considerations for managing UTIs and catheter removal include:
- Discontinuing catheter use as soon as possible to minimize the risk of urinary tract infections 1
- Implementing excellent pericare and infection prevention strategies to minimize the risk of infections 1
- Monitoring temperature and treating if above 37·5°C, as well as assessing fluid status and urinary retention as part of vital sign assessments 1
From the Research
Urethral Inflammation and Swelling during UTI
- Urethral inflammation and swelling can occur during a urinary tract infection (UTI), especially in cases where an indwelling catheter is used 2.
- The use of indwelling catheters can lead to an inflammatory reaction of the urethral mucosa, which can cause stricture formation and other complications 2.
- The catheter material, particularly latex, can cause cytotoxic effects and inflammation within the urethral mucosa, contributing to urethral inflammation 2.
Complications of UTI and Catheter Use
- Complicated UTIs can occur in patients with structural or functional abnormalities of the urinary tract, or in those with altered defenses 3, 4, 5.
- The use of indwelling catheters can increase the risk of UTIs, and catheter-associated UTIs (CAUTIs) are a common type of healthcare-associated infection 6.
- CAUTIs can lead to worse patient outcomes and significant financial impacts on hospitals 6.
Removal of Foley Catheter during Antibiotic Treatment
- The removal of a Foley catheter too early in antibiotic treatment may lead to complications, including urethral inflammation and swelling, which can cause difficulty in voiding 2.
- It is essential to carefully manage the removal of the catheter and monitor the patient's condition to prevent such complications.