Is a urinary tract infection (UTI) in a patient with a Foley catheter considered a complicated UTI?

Urinary Tract Infections in Patients with Foley Catheters are Considered Complicated UTIs

Yes, a urinary tract infection (UTI) in a patient with a Foley catheter is definitively considered a complicated UTI. 1, 2, 3

Why Catheter-Associated UTIs are Classified as Complicated

• Catheter-associated UTIs (CAUTIs) are classified as complicated UTIs due to the presence of a foreign body (the catheter) which represents a structural abnormality in the urinary tract 1, 4
• The European Association of Urology explicitly recommends treating symptomatic CAUTIs according to the recommendations for complicated UTIs 1
• CAUTIs involve different pathophysiology compared to uncomplicated UTIs, with biofilm formation on catheter surfaces that protects bacteria from both antimicrobials and host immune responses 4, 5

Microbiology Differences in CAUTIs

• CAUTIs have a broader microbial spectrum than uncomplicated UTIs, including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 2, 6
• The presence of a catheter increases the risk of polymicrobial infections, with up to 13% of CAUTIs involving multiple bacterial species 6
• Prior antibiotic administration further alters the pathogen distribution, increasing the probability of resistant organisms like Pseudomonas and Serratia 6

Management Implications of Complicated UTI Status

• A urine culture should always be obtained prior to initiating antimicrobial therapy for CAUTIs due to the wide spectrum of potential infecting organisms and increased likelihood of antimicrobial resistance 1
• If the indwelling catheter has been in place for ≥2 weeks and is still indicated, it should be replaced before starting antimicrobial therapy to hasten symptom resolution and reduce the risk of subsequent infection 1, 2
• Treatment duration is typically longer for CAUTIs than for uncomplicated UTIs: 7 days for patients with prompt symptom resolution and 10-14 days for those with delayed response 1, 2

Antibiotic Selection Considerations

• First-line empirical treatment options for CAUTIs include:
  • Intravenous third-generation cephalosporins 2
  • Amoxicillin plus an aminoglycoside 2
  • Second-generation cephalosporin plus an aminoglycoside 2
• Local antimicrobial resistance patterns should guide empirical therapy choices 2
• Fluoroquinolones like levofloxacin (750 mg once daily for 5 days) may be considered in patients with mild CAUTIs who are not severely ill 1

Prevention Strategies

• The duration of catheterization should be minimized as it is the most important risk factor for CAUTI development 1, 2
• Hydrophilic coated catheters should be used to reduce CAUTI risk 1
• Prophylactic antimicrobials should not be used to prevent CAUTIs 1
• Topical antiseptics or antimicrobials should not be applied to the catheter, urethra, or meatus 1

Clinical Implications

• CAUTIs are the leading cause of secondary healthcare-associated bacteremia, with approximately 20% of hospital-acquired bacteremias arising from the urinary tract 2
• Asymptomatic catheter-associated bacteriuria should not be treated with antimicrobials except before traumatic urinary tract interventions 1, 5
• The presence of a catheter significantly increases the risk of bacteremia and other urinary complications compared to patients without catheters 5