Should a Foley catheter be removed in a patient with a urinary tract infection (UTI)?

From the Guidelines

A Foley catheter should be removed in a patient with a urinary tract infection (UTI) if it is no longer medically necessary, as the catheter can perpetuate the infection. The decision to remove the catheter is guided by the principle of reducing the risk of ongoing infection and promoting resolution of symptoms. According to the 2009 international clinical practice guidelines from the Infectious Diseases Society of America 1, if an indwelling catheter has been in place for an extended period and is still indicated, replacement of the catheter is recommended to hasten resolution of symptoms and reduce the risk of subsequent infections.

Before removing the catheter, it is essential to initiate appropriate antibiotic therapy based on culture results or empiric coverage with agents like nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones, depending on local resistance patterns. Key considerations include:

• Obtaining a urine specimen for culture prior to initiating antimicrobial therapy to guide treatment decisions 1
• Assessing the medical necessity of the catheter and removing it if possible
• Replacing the catheter with a new one if it must remain in place, after starting antibiotics, to remove the biofilm-containing device

The rationale for catheter removal or replacement stems from the fact that indwelling catheters facilitate bacterial colonization and biofilm formation, which protects pathogens from both antibiotics and the body's immune defenses, making infection resolution more difficult while the catheter remains in place. By prioritizing catheter removal or replacement, healthcare providers can improve patient outcomes by reducing morbidity, mortality, and enhancing quality of life.

From the Research

Removal of Foley Catheter in Patients with UTI

• The decision to remove a Foley catheter in a patient with a urinary tract infection (UTI) should be based on individual patient needs and medical judgment 2, 3, 4, 5, 6.
• Studies have shown that the duration of urinary catheterization is a significant risk factor for the development of catheter-associated UTIs (CAUTIs) 3, 4, 5.
• Removing the catheter may reduce the risk of symptomatic CAUTI, but it may also increase the risk of requiring recatheterization 3.
• Proper aseptic practices for catheter insertion and maintenance, as well as the use of a closed catheter collection system, are essential for preventing CAUTIs 4.
• Alternatives to indwelling catheters should be considered in appropriate patients, and healthcare practitioners should regularly assess whether the catheter is still necessary 4, 6.

Considerations for Catheter Removal

• The time of day for catheter removal may not significantly impact the risk of developing symptomatic CAUTI, but removing the catheter late at night may slightly reduce the risk of requiring recatheterization 3.
• The use of prophylactic alpha blockers before catheter removal may not have a significant effect on the risk of requiring recatheterization or developing symptomatic CAUTI 3.
• Patients with indwelling urinary catheters are at risk for CAUTIs, which can have worse patient outcomes and significant financial impacts on hospitals 5.

Patient Care and Monitoring

• Healthcare practitioners should outline the procedure for the safe removal of a urinary catheter, including patient care and monitoring required before, during, and after the procedure 6.
• Complications associated with catheter removal, such as healthcare-associated infection and trauma to the neck of the bladder, should be prevented and managed 6.