Makindo Medical Notes

💡 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

• NICE NG113: Urinary tract infection (catheter-associated)

📝 Revisions

• Last updated: September 2025