Most Common Clinical Presentation of Catheter-Associated UTI
Fever is the most common clinical presentation of catheter-associated urinary tract infection, often accompanied by systemic symptoms rather than localized urinary complaints. 1
Primary Clinical Manifestations
The 2024 European Association of Urology guidelines explicitly list the signs and systemic symptoms compatible with catheter-associated UTI, with fever being the predominant presenting feature, followed by:
- New onset or worsening of fever 1
- Rigor (shaking chills) 1
- Altered mental status 1
- Malaise or lethargy with no other identified cause 1
Secondary Manifestations
Additional presentations include:
- Flank pain or costovertebral angle tenderness 1
- Acute hematuria 1
- Pelvic discomfort 1
- Dysuria, urgency, frequency, or suprapubic pain/tenderness (primarily in patients whose catheter has been removed) 1
Why Fever Predominates Over Other Options
Frequency (Option D) is notably absent as a primary symptom in catheterized patients because the catheter bypasses normal voiding mechanisms—patients cannot experience urinary frequency while continuously draining through an indwelling catheter. 1
Spasticity (Option C) is not a recognized clinical manifestation of catheter-associated UTI in the major guidelines, though it may occur in patients with neurogenic bladder from other causes. 1
Malaise (Option B), while present, is a nonspecific systemic symptom that accompanies fever rather than being the primary presenting feature. 1
Clinical Context and Severity
Catheter-associated UTIs represent serious infections with significant morbidity and mortality implications:
- Approximately 20% of hospital-acquired bacteremias arise from the urinary tract 1
- Mortality associated with CA-UTI bacteremia is approximately 10% 1
- The systemic nature of presentation (fever, rigors, altered mental status) reflects the propensity for these infections to progress to bacteremia and sepsis 1