Makindo Medical Notes

The best practice is to avoid unnecessary catheterization. If a catheter is required, the longer it remains in place, the higher the likelihood of bacteriuria. After one month, nearly all patients with indwelling catheters will develop bacteriuria, but antibiotic treatment is not routinely recommended for asymptomatic cases.

About

• A catheter-associated urinary tract infection (UTI) refers to a symptomatic infection of the bladder or kidneys in a person with a urinary catheter.
• Prolonged catheter use increases the likelihood of bacterial colonization. Asymptomatic bacteriuria is common and does not typically require antibiotic treatment unless symptomatic.

Clinical Features

• Cloudy urine, blood in the urine (hematuria), strong odor, or urine leakage around the catheter.
• Lower back or abdominal pain, fever, chills, unexplained fatigue, or vomiting.

Investigations

• If the catheter has been changed, collect a urine sample from the new catheter.
• If the catheter has been removed, obtain a midstream urine specimen (MSU).
• Send the urine sample for culture and susceptibility testing, noting any suspicion of a catheter-associated infection.

Management

• Consider removing or replacing the catheter as soon as possible if it has been in place for more than 7 days, but do not delay starting antibiotics.
• Before initiating antibiotics, obtain a urine sample from the catheter using aseptic technique.
• Offer an antibiotic based on symptom severity, risk of complications (e.g., structural or functional abnormalities, immunosuppression), previous urine culture results, and prior antibiotic use.

Choosing an Antibiotic

• Take into account the severity of symptoms and the patient’s risk factors for complications.
• Review previous urine culture and antibiotic susceptibility results if available.
• Use narrow-spectrum antibiotics whenever possible based on culture results. Modify the antibiotic if cultures reveal resistant bacteria.
• Provide advice on self-care, including potential side effects of antibiotics (e.g., diarrhoea, nausea) and seeking medical help if symptoms worsen or fail to improve within 48 hours.

Refer Patients to Hospital if They Have:

• Signs of sepsis or other serious illnesses.
• Significant dehydration or inability to tolerate fluids or medications orally.
• Are pregnant.
• Higher risk of complications due to structural or functional abnormalities, or underlying diseases like diabetes or immunosuppression.
• Recurrent catheter-associated UTIs or bacteria resistant to oral antibiotics.

Management of Simple UTI in Non-Pregnant Adults

• Nitrofurantoin: 100 mg modified-release twice daily (or 50 mg four times daily) for 7 days if eGFR ≥ 45 mL/min.
• Trimethoprim: 200 mg twice daily for 7 days, if the risk of resistance is low.
• Amoxicillin: 500 mg three times daily for 7 days, only if culture results show susceptibility.

IV Antibiotics for Sepsis or Vomiting

• Co-Amoxiclav: 500/125 mg three times a day for 7–10 days if cultures show susceptibility.
• Ciprofloxacin: 500 mg twice daily for 7 days (consider safety issues).
• Gentamicin: 5 mg/kg once daily, with dose adjustments based on serum concentration.
• Amikacin: Initially 15 mg/kg once daily, with dose adjustments based on serum concentration (maximum 1.5 g per dose).

UTI Management in Pregnancy

• Cefalexin: 500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7–10 days.
• If unable to take oral antibiotics or if severely unwell, use IV antibiotics:Cefuroxime: 750 mg to 1.5 g three or four times a day.

References

• NICE guidance on urinary tract infections