From the Guidelines
Diagnosing a UTI in a patient with a chronic Foley catheter requires careful assessment, and the catheter should be changed prior to specimen collection if urosepsis is suspected, as recommended by the Infectious Diseases Society of America 1. To diagnose a UTI in a patient with a chronic Foley catheter, it's essential to look for systemic signs of infection, such as fever, rigors, altered mental status, malaise, lethargy, flank pain, or costovertebral angle tenderness, without other identified causes, along with a positive urine culture 1. The following steps should be taken:
- Replace the catheter and collect a urine specimen from the fresh catheter rather than from the collection bag, as this method is more likely to yield accurate results 1.
- Perform urinalysis for determination of leukocyte esterase and nitrite level by use of a dipstick and a microscopic examination for WBCs, and only order a urine culture if pyuria (≥10 WBCs/high-power field or a positive leukocyte esterase or nitrite test is present on dipstick) 1.
- If urosepsis is suspected, obtain urine and paired blood specimens for culture and antimicrobial susceptibility testing, and request a Gram stain of uncentrifuged urine 1. Some key points to consider:
- Pyuria alone (>10 WBC/HPF) is not diagnostic, as it's commonly present in catheterized patients without infection 1.
- Asymptomatic bacteriuria is almost universal in long-term catheterized patients and doesn't require antibiotics unless the patient is symptomatic or undergoing urologic procedures 1.
- The culture should show bacterial growth of ≥10³ CFU/mL of one or more organisms to confirm the diagnosis of CAUTI 1.
From the Research
Diagnosing UTI in Patients with Chronic Foley Catheter
To diagnose a urinary tract infection (UTI) in a patient with a chronic Foley catheter, consider the following:
- The presence of a Foley catheter increases the risk of developing a UTI, as it provides a conduit for bacteria to enter the urinary tract 2
- Patients with chronic Foley catheters are at higher risk of developing catheter-associated urinary tract infections (CAUTIs) 2
- The diagnosis of a UTI in a patient with a chronic Foley catheter should be based on clinical symptoms, such as fever, chills, and dysuria, as well as laboratory tests, including urine culture and sensitivity 3, 4
Clinical Presentation and Laboratory Tests
Some key points to consider when diagnosing a UTI in a patient with a chronic Foley catheter include:
- Clinical presentation: patients may present with symptoms such as fever, chills, dysuria, and flank pain 4
- Laboratory tests: urine culture and sensitivity are essential in diagnosing a UTI and guiding antibiotic therapy 3, 4
- Imaging studies: may be necessary to rule out complications, such as pyelonephritis or sepsis 4
Antibiotic Resistance and Treatment
It is essential to consider antibiotic resistance when treating UTIs in patients with chronic Foley catheters:
- Antibiotic resistance is a growing concern in the treatment of UTIs, and knowledge of local susceptibility patterns is crucial in guiding empiric antibiotic therapy 3
- Treatment options for UTIs in patients with chronic Foley catheters may include fluoroquinolones, such as levofloxacin, as well as other antibiotics, such as cefepime and piperacillin-tazobactam 3, 4, 5, 6