Catheter-Associated Urinary Tract Infection (CAUTI)
Prevention Strategies
The single most effective prevention strategy is to avoid unnecessary catheterization and remove catheters as soon as clinically possible, as duration of catheterization is the most important modifiable risk factor for CAUTI. 1, 2, 3, 4
Primary Prevention Measures
Limit catheter placement to specific indications only: acute urinary retention, accurate urine output monitoring in critically ill patients, perioperative use for specific surgical procedures, and comfort care in end-of-life situations 2, 3
Remove catheters immediately when no longer meeting specific clinical criteria, as each additional day increases infection risk 1, 3, 4
Implement reminder systems (electronic or manual) to prompt daily assessment of catheter necessity, which effectively decreases CAUTI rates 1, 3
Use aseptic technique during catheter insertion with proper hand hygiene and sterile equipment 4
Maintain closed drainage systems and keep collection bags below bladder level at all times 4
Catheter Selection
Use hydrophilic-coated catheters for clean intermittent catheterization, as these effectively reduce infection rates 1
Consider chlorhexidine-coated catheters based on preliminary promising results, though routine antimicrobial-impregnated catheters lack sufficient evidence for universal recommendation 1, 3
Avoid suprapubic catheterization as a routine alternative, since it offers no superiority over urethral catheters in reducing bacteriuria 1
Implementation Programs
Establish infection control programs with staff education on proper catheter insertion technique, maintenance, and removal protocols 1, 3
Train nursing personnel specifically on catheter care, as this measurably lowers CAUTI incidence 3
Diagnostic Criteria
CAUTI requires both the presence of an indwelling catheter (or removal within 48 hours) AND clinical signs/symptoms of infection, not just positive urine culture alone. 5, 2
Required Elements for Diagnosis
Catheter presence: Indwelling urinary catheter currently in place or removed within the previous 48 hours 2
Clinical symptoms: At least one of the following:
Positive urine culture: ≥10³ colony-forming units/mL of uropathogenic bacteria 2
Critical Distinction
Do NOT treat asymptomatic bacteriuria, which is bacterial colonization without clinical symptoms and occurs in the majority of catheterized patients after several days 5, 3
Pyuria alone is NOT diagnostic of CAUTI, as white blood cells in urine are expected with catheterization 2
Antimicrobial Treatment
For serious CAUTI in patients with prior antibiotic exposure or healthcare-associated bacteremia, initiate empirical broad-spectrum antibiotics with activity against multidrug-resistant uropathogens, then narrow therapy based on culture results. 1
Empirical Therapy Approach
Start broad-spectrum coverage immediately in septic or hemodynamically unstable patients before culture results 1
Target multidrug-resistant organisms (including extended-spectrum beta-lactamase producers and carbapenem-resistant Enterobacteriaceae) in patients with:
Remove or replace the catheter when feasible during treatment, as biofilm on catheter surfaces harbors bacteria and impedes antibiotic penetration 5
Treatment Duration and De-escalation
Narrow antibiotic spectrum once culture and susceptibility results are available 1
Treat for 7 days for uncomplicated CAUTI with prompt clinical response 2
Extend to 10-14 days for delayed clinical response or complicated infection 2
Common Pitfall
Avoid treating asymptomatic bacteriuria, as this leads to unnecessary antibiotic use, promotes resistant organism development, and provides no clinical benefit to the patient 5, 3. Many healthcare practitioners incorrectly treat positive urine cultures without clinical symptoms, contributing to antibiotic overuse and resistance 5.