Catheter Related UTI
💡 Best practice: avoid unnecessary catheterisation.
The longer a catheter remains in place, the higher the risk of bacteriuria.
➡️ After 1 month, almost all patients with indwelling catheters will have bacteriuria - but antibiotics are NOT recommended unless the patient is symptomatic.
🔎 About
- A catheter-associated UTI (CAUTI) = symptomatic infection of the bladder or kidneys in a patient with a urinary catheter.
- Prolonged catheter use → bacterial colonisation is inevitable, but asymptomatic bacteriuria rarely needs antibiotics.
🩺 Clinical Features
- Cloudy urine, haematuria, malodour, or leakage around catheter.
- Fever, chills, abdominal or loin pain.
- Unexplained fatigue, delirium, or vomiting (especially in elderly/frail patients).
🧪 Investigations
- If catheter changed → send urine sample from NEW catheter.
- If catheter removed → obtain MSU (mid-stream urine).
- Send sample for culture + sensitivity 🧫 (document suspicion of CAUTI).
💊 Management
- Remove or replace catheter ASAP if >7 days in place (do not delay antibiotics if unwell).
- Obtain urine sample before starting antibiotics (aseptic technique).
- Antibiotic choice depends on:
- Severity of symptoms 🚨
- Risk of complications (structural abnormality, immunosuppression, diabetes)
- Previous urine culture + antibiotic resistance history
- Use narrow-spectrum antibiotics where possible, based on culture results.
- Patient advice: side effects (diarrhoea, nausea), and seek help if no improvement in 48h.
🏥 Refer to Hospital if
- Sepsis or septic shock.
- Unable to tolerate fluids or antibiotics orally (vomiting, severe dehydration).
- Pregnant 🤰.
- High-risk patients: structural urinary abnormalities, immunosuppression, recurrent CAUTI.
- Resistant bacteria → no oral options available.
💊 Antibiotic Choices (Non-Pregnant Adults)
- Nitrofurantoin: 100 mg MR BD (or 50 mg QDS) × 7 days (if eGFR ≥45).
- Trimethoprim: 200 mg BD × 7 days (if low risk of resistance).
- Amoxicillin: 500 mg TDS × 7 days (only if culture shows sensitivity).
💉 IV Antibiotics (Sepsis/Vomiting)
- Co-Amoxiclav: 500/125 mg TDS × 7–10 days (if sensitive).
- Ciprofloxacin: 500 mg BD × 7 days (caution: safety profile ⚠️).
- Gentamicin: 5 mg/kg OD (adjust per serum levels).
- Amikacin: 15 mg/kg OD (max 1.5 g/dose; monitor levels).
🤰 UTI in Pregnancy
- Cefalexin: 500 mg BD/TDS × 7–10 days (up to 1–1.5 g QDS for severe cases).
- If IV needed → Cefuroxime: 750 mg–1.5 g TDS/QDS.
📚 References
📝 Revisions
- Last updated: September 2025
