Table of contents
Catheter-associated urinary tract infection
What's new
Updated 2024 EAU guidelines for the diagnosis and management of catheter-associated urinary tract infection.
Background
Overview
Definition
CA-UTI is a common hospital-acquired infection characterized by various medical complications such as catheter encrustation, bladder stones, septicemia, endotoxic shock, and pyelonephritis.
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Pathophysiology
Colonization of the urinary catheter and/or uroepithelial cells, evasion of host defenses, replication, and damage to host cells by uropathogens are involved in the development of CA-UTI. Common microbiological agents include E. coli, P. mirabilis, P. aeruginosa, S. aureus, S. epidermidis, K. pneumoniae, P. vulgaris, C. freundii, Providentia rettgeri, and C. albicans.
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Disease course
Clinical manifestations include fever, urethritis, cystitis, acute pyelonephritis, renal scarring, calculus formation, and bacteremia. Disease progression may lead to urosepsis and death.
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Prognosis and risk of recurrence
Several studies report an association between catheter-associated infection, increased mortality, and prolonged length of stay in acute care facilities.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of catheter-associated urinary tract infection are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the European Association of Urology (EAU 2024), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC 2017), and the Infectious Diseases Society of America (IDSA 2010).
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Screening and diagnosis
Diagnostic criteria
As per SEIMC 2017 guidelines:
Diagnose CA-UTI in patients:
with indwelling urethral, indwelling suprapubic, or intermittent catheterization
symptomatic UTI
growth of ≥ 10³ CFU/mL of a bacterial species in a single catheter urine specimen or a midstream voided urine specimen from a patient whose urethral, suprapubic, or condom catheter has been removed within the previous 48 hours
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View any number of bacteria in bladder urine obtained by suprapubic aspiration as significant.
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Microbiological etiologies
Diagnostic investigations
Clinical history: as per EAU 2024 guidelines, do not use the presence or absence of odorous or cloudy urine alone to differentiate CA-ASB from CA-UTI.
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Urinalysis
Gram stain
Urine culture
Medical management
General principles
As per EAU 2024 guidelines:
Treat symptomatic CA-UTIs according to the recommendations for complicated UTIs.
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Manage any urological abnormality and/or underlying complicating factors.
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Antibiotic therapy
Duration of antibiotics
Therapeutic procedures
Specific circumstances
Patients with asymptomatic bacteriuria
As per EAU 2024 guidelines:
Do not treat CA-ASB in general.
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Treat CA-ASB before traumatic urinary tract interventions, such as TURP.
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Patients with urosepsis
Preventative measures
Minimization of catheter use: as per AAFP 2024 guidelines, assess the need for indwelling urinary catheters regularly, and remove then as soon as indicated.
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Alternatives to indwelling catheters
Catheter insertion technique
Closed catheter systems
Antimicrobial-coated catheters
Routine catheter change
Catheter irrigation technique
Meatal care
Antibiotic prophylaxis with catheter placement/removal
Systemic antibiotic prophylaxis
Topical antimicrobial prophylaxis
Drainage bag antimicrobials
Methenamine salt prophylaxis
Cranberry products
Quality improvement
Infection prevention: as per IDSA 2010 guidelines, ensure that hospitals and long-term care facilities develop, maintain, and promulgate policies and procedures for recommended catheter insertion indications, insertion and maintenance techniques, discontinuation strategies, and replacement indications, and include education and training of their staff relevant to these policies and procedures.
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