From the Guidelines
Asymptomatic bacteriuria in patients with indwelling urinary catheters should not be treated with antibiotics, and routine Foley catheter exchange is not recommended. The management of asymptomatic bacteriuria in patients with indwelling catheters should focus on preventing complications and promoting patient safety, rather than treating the bacteriuria itself. According to the 2019 clinical practice guideline for the management of asymptomatic bacteriuria by the Infectious Diseases Society of America 1, there is no benefit to screening for or treating asymptomatic bacteriuria in catheterized patients, and antimicrobial therapy can cause harm, including adverse effects, increased costs, and the risk of antimicrobial-resistant infections.
Key Considerations
- Nearly all patients with long-term indwelling catheters will develop bacteriuria, which represents colonization rather than infection 1.
- Antibiotic treatment in these cases does not reduce complications or prevent symptomatic infections, but instead promotes antimicrobial resistance and exposes patients to unnecessary medication side effects 1.
- Antibiotics should only be initiated when patients develop signs and symptoms of a urinary tract infection, such as fever, suprapubic or flank pain, altered mental status without another identified cause, or acute hematuria.
- For catheterized patients who do develop symptomatic infections, catheter replacement before starting antibiotics can help improve outcomes by removing biofilm-containing catheters.
Prevention Strategies
- To reduce the risk of catheter-associated bacteriuria, healthcare providers should minimize catheter use, ensure proper aseptic technique during insertion, maintain a closed drainage system, and remove catheters as soon as they are no longer necessary 1.
- Daily assessment of catheter necessity is an important practice to reduce catheter duration and associated complications.
From the Research
Management of Asymptomatic Bacteriuria in Patients with Indwelling Catheters
- Asymptomatic bacteriuria is a common condition in patients with indwelling catheters, and routine treatment is not recommended 2, 3, 4, 5, 6.
- The presence of a biofilm on the catheter can lead to persistent infections that are resistant to antimicrobial therapy, making treatment of asymptomatic bacteriuria ineffective 2.
- Changing the catheter before collecting urine can improve the accuracy of urine culture results and may also improve the response to antibiotic therapy by removing the biofilm 2.
- However, there is no proven effective strategy for preventing catheter-associated urinary tract infections in patients who are chronically catheterized 2.
Role of Foley Catheter Exchange
- Foley catheter exchange may be considered when symptoms of a urinary tract infection develop in a patient with an indwelling catheter 2.
- Changing the catheter may help remove the biofilm that can serve as a nidus for reinfection, potentially improving the response to antibiotic therapy 2.
- However, routine exchange of Foley catheters is not recommended for asymptomatic bacteriuria, as it may not provide any clinical benefit and can increase the risk of complications 3, 4, 5, 6.
Antibiotic Treatment
- Antibiotic treatment is not recommended for asymptomatic bacteriuria in patients with indwelling catheters, as it is unlikely to confer clinical benefit and can contribute to antibiotic resistance 3, 4, 5, 6.
- Treatment should be reserved for patients with symptomatic urinary tract infections, and the choice of antibiotic should be guided by the results of urine culture and susceptibility testing 4, 5.