From the Guidelines
A Foley catheter should be removed or replaced in a patient with a urinary tract infection (UTI) if it is the likely source of infection or is no longer medically necessary, as recommended by the Infectious Diseases Society of America guidelines 1. When managing a patient with a UTI and an indwelling catheter, it is crucial to consider the catheter as a potential source of infection. The guidelines suggest that if an indwelling catheter has been in place for an extended period, such as 12 weeks, and is still indicated at the onset of catheter-associated UTI (CA-UTI), the catheter should be replaced to hasten resolution of symptoms and reduce the risk of subsequent infections 1. Key considerations for catheter management in patients with UTI include:
- Removing the catheter if it is no longer medically necessary to prevent further infection and promote healing
- Replacing the catheter with a new one before starting antibiotic treatment if continued bladder drainage is required
- Daily reassessment of the need for catheterization to remove the catheter as soon as it is no longer clinically indicated The decision to remove or replace a Foley catheter in a patient with a UTI should prioritize reducing the risk of infection and promoting effective treatment, as supported by the guidelines from the Infectious Diseases Society of America 1.
From the Research
Removal of Foley Catheter in Patients with UTI
- The decision to remove a Foley catheter in patients with a urinary tract infection (UTI) is crucial in preventing further complications 2, 3, 4, 5.
- Studies have shown that early removal of the catheter is one of the mainstays of prevention, as 100% of catheters become colonized 2.
- Catheter-associated urinary tract infections (CAUTIs) are a significant concern, and minimizing indwelling device usage and stopping the catheter as soon as medically possible are essential preventative measures 5.
- Research has also focused on developing catheters with antimicrobial and anti-fouling properties to resist colonization by bacterial pathogens 3.
Benefits of Removing the Foley Catheter
- Removing the Foley catheter can lead to a decrease in the rate of hospital-acquired UTI and positively affect other perioperative outcomes, such as decreased time to surgery, shorter length of stay, and lower total inpatient cost 4.
- A study found that patients without indwelling Foley catheters experienced lower odds of hospital-acquired UTI, higher odds of home discharge, and decreased time to surgery, shorter length of stay, and lower total inpatient cost compared to those with indwelling Foley catheters 4.
Prevention of CAUTIs
- Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions, including monitoring device use, the suitability of device justifications, and problems 5.
- Technological advancements in device substances that inhibit colony generation will be necessary to avoid these infestations 5.
- Antibiotic prophylaxis at urinary catheter removal can also prevent urinary tract infections, with a significant reduction in the rate of symptomatic urinary tract infections and bacteriuria 6.