Catheter Associated UTIs

Question 1

What is the definition of CAUTI?

Answer 1

symptoms consistent w UTI w no other identified source of infection + ≥ 103 CFU of single bacterial species; either from single catheter urine specimen, or in mid-stream urine (MSU) voided specimen if urethral/suprapubic/condom catheter removed within 48h

Question 2

What is the signs and symptoms in CAUTI?

Answer 2

• Fever, rigors, malaise, altered mental state (AMS)/delirium, or lethargy w no other identified cause (CAUTI is dx of exclusion)
• Flank pain, costovertebral angle tenderness, pelvic discomfort
• Acute haematuria
• note: pts on catheter won’t have LUTS as they are not really peeing

In pts whose catheters have been removed: dysuria, urgency/frequency, suprapubic pain/tenderness (LUTS)

In pts w spinal cord injury (SCI), these are considered UTI symptoms : ↑spasticity, autonomic dysreflexia (e.g. blood pressure fluctuations), sense of unease

Question 3

How to prevent CAUTI?

Answer 3

• Limit unnecessary catheters;
• Discontinue catheters ASAP
• Infection prevention during insertion, maintenance and replacement –> Minimise disconnecting catheter junction AND Keep drainage bag and connecting tube below the level of the bladder at all times
• Consider alternatives: condom catheter/clean intermittent catheter (CIC)

Question 4

How to treat CAUTI?

Answer 4

Obtain urine culture prior to antibiotics (because of the wide spectrum of potential infecting organisms and resistance).

If IDC in place > 2 weeks at the start of onset of CAUTI and still indicated, should be replaced to hasten resolution of symptoms and reduce risk of subsequent CA- bacteriuria and CA- UTI

TTSH empirical abx guidelines (usually 7 days)

• [First line] IV cefepime (2g Q12h) + IV gentamicin (single dose STAT)
• Gentamicin dosed once due to post antibiotic effect (PAE), which will last 48 hours, which is when the c/s results come back and will be able to tell us if gentamicin should be continued