UTI Flashcards
Approximate daily incidence of bacteriuria in catheterized patients
5% per day
Percent of patients with catheter associated bacteriuria who develop UTI
<25%
CFU cutoff for CA-UTI
CA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source along with !103 cfu/mL of !1 bacterial species in a single catheter urine specimen or in a midstream voided urine specimen from a patient whose urethral, supra- pubic or condom catheter has been removed within the pre- vious 48 h
CFU cutoff for catheter-associated ASB
CA-ASB in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of !105 cfu/mL of !1 bacterial species in a single catheter urine specimen in a patient without symptoms com- patible with UTI
Value of pyuria in diagnosis of catheter-associated UTI
In the catheterized patient, pyuria is not diagnostic of CA-bacteriuria or CA-UTI (AII). i. The presence, absence, or degree of pyuria should not be used to differentiate CA-ASB from CA-UTI (A-II). ii. Pyuria accompanying CA-ASB should not be interpreted as an indication for antimicrobial treatment (A-II). iii. The absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI (A-III).
Signs/Sxs of UTI in CA-UTI patients
Signs and symptoms compatible with CA-UTI include new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain; costovertebral angle tenderness; acute hematuria; pelvic dis- comfort; and in those whose catheters have been removed, dysuria, urgent or frequent urination, or suprapubic pain or tenderness
Catheterized patients with CA-UTI usually do not manifest the classic symptoms of dysuria, frequent urination, and urgent urination, although such symptoms may occur in CA-UTI after the catheter has been removed
Antibacterial prophylaxis in patients with urinary catheters
Systemic antimicrobial prophylaxis should not be rou- tinely used in patients with short-term (A-III) or long-term (A-II) catheterization, including patients who undergo surgical procedures, to reduce CA-bacteriuria or CA-UTI because of concern about selection of antimicrobial resistance.
Role of methenamine in catheter-associated urinary tract infections
Methenamine salts should not be used routinely to re- duce CA-bacteriuria or CA-UTI in patients with long-term intermittent (A-II) or long-term indwelling urethral or supra- pubic (A-III) catheterization
Methenamine salts may be considered for the reduction of CA-bacteriuria and CA-UTI in patients after a gynecologic surgical procedure who are catheterized for no more than 1 week (C-I). It is reasonable to assume that a similar effect would be seen after other types of surgical procedures.
Methenamine is generally considered to have limited effec- tiveness in catheterized patients for whom the dwell time, and thus the time for hydrolysis to formaldehyde, is limite
When using a methenamine salt to reduce CA-UTI, the urinary pH should be maintained below 6.0
Populations to screen and treat for asymptomatic bacteriuria
Screening for and treatment of CA-ASB are not rec- ommended to reduce subsequent CA-bacteriuria or CA-UTI in patients with short-term (A-II) or long-term (A-I) indwelling urethral catheters.
Screening for and treatment of CA-ASB are not rec- ommended to reduce subsequent CA-bacteriuria or CA-UTI in other catheterized patients (A-III), except in pregnant women (A-III) and patients who undergo urologic procedures for which visible mucosal bleeding is anticipated (A-III).
management of catheter-associated UTI
Seven days is the recommended duration of antimi- crobial treatment for patients with CA-UTI who have prompt resolution of symptoms (A-III), and 10–14 days of treatment is recommended for those with a delayed response (A-III), regardless of whether the patient remains catheterized or not
Use of the urinary catheter should always be discontinued as soon as appropriate. A 7–14-day regimen is recommended for most patients with CA-UTI, regardless whether the patient remains catheterized or not
A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI be- cause of the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance
If an indwelling catheter has been in place for 12 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced to hasten resolution of symptoms and to reduce the risk of subsequent CA-bacteriuria and CA-UTI (A-I).
