Catheter Related UTI

Treatment is only needed for symptomatic catheter-associated UTI not asymptomatic bacteriuria (apart from in pregnant women with asymptomatic bacteriuria)

Introduction

• Catheter-associated UTI occurs when bacteria in a catheter bypass the body’s defence mechanisms (such as the urethra and the passing of urine) and enter the bladder
• The longer a catheter is in place, the more likely bacteria will be found in the urine
• Treatment is only needed for symptomatic catheter-associated UTI not asymptomatic bacteriuria (apart from in pregnant women with asymptomatic bacteriuria)

Investigations

• Obtain a urine sample from the sampling port of the catheter using an aseptic technique (in line with the NICE guideline on healthcare-associated infection) and send for culture and susceptibility testing.
• If the catheter has been changed, obtain the sample from the new catheter. If the catheter has been removed obtain a midstream specimen of urine

Management

• Consider removing or changing the catheter before treating the infection if it has been in place for more than 7 days. Catheters should be removed rather than changed where possible
• Check that the catheter is correctly positioned, drains correctly and is not blocked. Do not allow catheter removal or change to delay antibiotic treatment. Do not give antibiotic prophylaxis for catheter changes unless the person has a history of symptomatic UTIs due to catheter change
• First choice oral antibiotic if no upper UTI symptoms
  • Nitrofurantoin if eGFR ≥ 45 ml/minute 50 mg QDS or 100 mg MR BD for 7 days
  • Trimethoprim if low risk of resistance and not used in the past 3 months 200 mg BD for 7 days
  • Amoxicillin (only if culture results available and susceptible) 500 mg TDS for 7 days
• Second choice
  • no upper UTI symptoms Pivmecillinam 400 mg stat , then 200 mg TDS for 7 days
  • Fosfomycin 3 g single dose sachet
• Upper UTI symptoms:
  • 1st choice: Co-Amoxiclav 625 mg three times a day for 7 days
  • Ciprofloxacin 500 mg twice a day for 7 days
  • Levofloxacin 500 mg once a day for 7 days
  • Trimethoprim (only if culture results available and susceptible) 200 mg twice a day for 14 days
• First choice intravenous antibiotic (if vomiting, unable to take oral antibiotics or severely unwell). Antibiotics may be combined if sepsis a concern.
• Review IV antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total antibiotic course of 7 days
  • Co-Amoxiclav 1.2 g three times a day
  • Ciprofloxacin 400 mg twice or three times a day
  • Ceftriaxone 1 to 2 g once a day
  • Gentamicin 5 mg/kg to 7 mg/kg once a day
  • Amikacin 15 mg/kg once a day

Pregnancy age over 12

• Cefalexin 500 mg twice or three times a day for 7 days
• IV needed: Cefuroxime 750 mg three or four times a day