From the Guidelines
A urinary tract infection (UTI) in a patient with a chronic indwelling catheter is typically defined by the presence of symptoms such as new onset or worsening of fever, rigor, altered mental status, malaise, or lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute haematuria, and pelvic discomfort.
Key Considerations
- The diagnosis of UTI in patients with chronic indwelling catheters is challenging due to the high incidence of asymptomatic bacteriuria, which can lead to unnecessary antimicrobial treatment 1.
- Urine cultures are not reliable tests for patients with chronic urinary catheters or ileal conduits, as bacteriuria is almost always present regardless of symptoms 1.
- The presence of a positive urine analysis (UA) does not necessarily mean the patient has a UTI, as UA has a low specificity in diagnosing UTIs in patients with indwelling urinary catheters or ileal conduits 1.
- Catheter-associated UTIs (CA-UTIs) are often polymicrobial and caused by multidrug-resistant uropathogens, and urine cultures are recommended prior to treatment to confirm that an empirical regimen provides appropriate coverage 1.
- Replacement of the indwelling catheter prior to antimicrobial treatment for CA-UTI is recommended if the catheter has been in place for at least 2 weeks and its use cannot be discontinued 1.
Symptoms and Diagnosis
- Symptoms compatible with CA-UTI include new onset or worsening of fever, rigor, altered mental status, malaise, or lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute haematuria, and pelvic discomfort, as well as dysuria, urgent or frequent urination, and suprapubic pain or tenderness in those whose catheter has been removed 1.
- A systematic review and meta-analysis demonstrated that patients at high risk of CA-UTI were female, had prolonged catheterisation duration, had diabetes, and had longer hospital and intensive care unit stays 1.
From the Research
Definition of Urinary Tract Infection (UTI) in Patients with Chronic Indwelling Catheter
A urinary tract infection (UTI) in a patient with a chronic indwelling catheter is typically defined by the presence of bacteriuria, which is the presence of bacteria in the urine [ 2 ]. The most common bacteria isolated in patients with chronic indwelling catheters are Escherichia coli (E coli), Klebsiella pneumoniae (K pneumoniae), and Proteus mirabilis (P mirabilis) [ 2 ].
Risk Factors for UTI in Patients with Chronic Indwelling Catheter
The main risk factor for developing a UTI in patients with a chronic indwelling catheter is the duration of catheterization [ 3, 4,5 ]. Other risk factors include the type of catheter used, the presence of biofilm on the catheter, and the patient's overall health status [ 5 ].
Diagnosis and Treatment of UTI in Patients with Chronic Indwelling Catheter
The diagnosis of a UTI in a patient with a chronic indwelling catheter is typically made based on the presence of symptoms such as fever, dysuria, and pyuria, as well as the results of urine cultures [ 6 ]. Treatment of a UTI in a patient with a chronic indwelling catheter typically involves the use of antibiotics, with the choice of antibiotic depending on the results of urine cultures and the patient's overall health status [ 5 ].
Prevention of UTI in Patients with Chronic Indwelling Catheter
Prevention of UTI in patients with a chronic indwelling catheter is crucial to reduce the risk of infection and its associated complications. Strategies for prevention include: