🦠 Catheter-Associated Urinary Tract Infection

Catheter-associated urinary tract infection (CAUTI) is one of the most common healthcare-associated infections, especially in hospitalized and catheterized patients.

Infection of the urinary tract occurring in a patient who has had an indwelling urinary catheter in place for more than 2 days or within 48 hours of catheter removal, without another identifiable source of infection.

Catheter-Associated Urinary Tract Infection Epidemiology

• Intraluminal route: entry via contaminated collection system.
• Extraluminal route: migration of organisms along the external surface.
• Biofilm formation on catheter surfaces contributes to persistence and antibiotic resistance.

• Gram-negative: E. coli, Klebsiella spp., Proteus spp., Pseudomonas spp.
• Gram-positive: Enterococcus spp., Staphylococcus aureus
• Fungi: Candida spp. (especially in patients with prolonged antibiotic use)

• Often asymptomatic, especially in chronically catheterized individuals.
• When symptomatic:
  • Fever
  • Suprapubic or flank pain
  • Hematuria
  • Mental status changes (elderly)
  • Sepsis or systemic signs

• Urine culture from catheter or freshly placed catheter: >10^5 CFU/mL
• Must correlate with clinical signs/symptoms.
• Do not screen or treat asymptomatic bacteriuria, except in specific cases (e.g., prior to urologic surgery).

• Targeted antibiotic therapy based on culture results.
• Duration:
  • 5–7 days: mild/moderate cases with good response.
  • 10–14 days: severe infection, bacteremia, or persistent symptoms.
• Catheter removal or exchange is essential.

• Avoid unnecessary catheterization.
• Use sterile technique for insertion.
• Maintain closed drainage system.
• Daily reassessment of catheter need.
• Use external catheters or intermittent catheterization when possible.
• Consider antimicrobial-impregnated catheters in high-risk patients.