Catheter associated urinary tract infection

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Including supra-pubic catheters

Diagnosis

  • Do not use urine dipstick to diagnosis catheter associated urinary tract infection 
  • Urine culture is often positive in catheterised patient; this does not differentiate between colonisation and infection
  • Catheter associated urinary tract infection is diagnosed clinically
Catheter associated urinary tract infection diagnosis is based on the following:
  • Temperature >38oC (this may be absent in older patients)
  • No evidence of focus of infection elsewhere
  • Any of the following signs or symptoms:
    • Rigor
    • Supra-pubic or flank pain
    • Frank haematuria
    • Delirium

Review the need for the catheter

  • Consider permanent removal
  • If catheter has been in for >7 days and cannot be permanently removed change the catheter (within 24 hours of starting antibiotics).

Recommended investigations

Recommended investigations:

  • Blood cultures
  • Catheter urine sample for culture

Antibiotic recommendation

Secondary care or Hospital@HomeGentamicin (use NHS Lothian Calculator located on AMT intranet page)
  • Give a single dose, take a gentamicin level at appropriate interval and change the catheter if appropriate.
  • If patient remains febrile after above follow  Upper Urinary Tract Infection/Pyelonephritis for further guidance. 
Primary careAntibiotics as per  Lower Urinary Tract Infection/Cystitis
  •  Duration: 7 days for both men and women

Use of antibiotics when changing a urinary catheter

Consider only in the following circumstances:

  • Previous history of symptomatic UTI with catheter change
  • Insertion of incontinence implant
  • Trauma at catheterisation

Single dose of gentamicin, assuming no gentamicin resistant bacteria has been isolated in last 6 months (use NHS Lothian Calculator located on AMT intranet page).