Alternative names
Catheter-associated UTI; Urinary tract infection - associated with a catheter

Definition
Catherer-associated urinary tract infection (UTI) is an infection such as a bladder infection that is associated with the use of catheters used to drain urine from the body.

Causes, incidence, and risk factors

The presence of a catheter within the urinary tract increases the likelihood of urinary tract infection. It may also increase the difficulty of treating the infection.

If a urinary catheter is left in place for long periods of time, bacteria will inevitably grow in it. A harmful infection may occur if the number of bacteria becomes large or if specific pathologic bacteria grow in the urinary tract.

Symptoms

 
• Pressure in the lower pelvis  
• Abnormal urine color (cloudy urine)  
• Blood in the urine (hematuria)  
• Foul or strong urine odor  
• Leakage of urine around the catheter

Additional symptoms that may be associated with this disease:

 
• Flank pain  
• Fatigue  
• Fever  
• Chills  
• Vomiting  
• Mental changes or confusion *

* Often in an elderly person, mental changes or confusion are the only signs of a possible urinary tract infection.

Signs and tests

 
• A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).  
• A urine culture maybe performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

Treatment

Mild cases of acute UTI may disappear spontaneously without treatment. However, because of the risk of the infection spreading to the kidneys (complicated UTI), treatment is usually recommended. Also, due to the high mortality rate in the elderly population, prompt treatment is recommended.

In most cases, treatment can be done on an outpatient basis.

MEDICATIONS:
Antibiotics may be used to control the bacterial infection. It is imperative that you finish the entire course of prescribed antibiotics. Commonly used antibiotics include:

 
• Nitrofurantoin  
• Sulfa drugs (sulfonamides)  
• Quinolones (ciprofloxacin)  
• Penicillins (amoxicillin)  
• Cephalosporins  
• Tetracyclines (doxycycline)

Phenazopyridine hydrochloride (Pyridium) may be used to reduce the burning and urinary urgency associated with cystitis.

SURGERY:
Surgery is generally not indicated for catheter-related urinary tract infection. However, chronic indwelling catheters (Foley or suprapubic tube) should be changed every month. Proper sterile technique must be used.

DIET:
Increasing the intake of fluids to 2,000 to 4,000 cc per day encourages frequent urination that flushes the bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine.

MONITORING:
Follow-up may include urine cultures to ensure that bacteria are no longer present in the bladder.

Expectations (prognosis)

Cystitis associated with catheters is often difficult to treat. Most people who have a catheter in place for any period of time will develop some degree of cystitis.

Complications

 
• Chronic or recurrent urinary tract infection  
• Complicated UTI  
• Pyelonephritis Calling your health care provider Call your health care provider if symptoms indicate cystitis or a catheter-related UTI might be present. If you have cystitis, call if symptoms worsen or new symptoms develop, especially fever, back or flank pain, and vomiting. Prevention Prevention starts with the health care provider. Except in special circumstances, all urinary catheters should be placed in a sterile fashion. Insertion of a non-sterile catheter or using a non-sterile technique is much more likely to result in a urinary tract infection. Routine care of the indwelling catheter MUST include daily cleansing of the urethral area and the catheter with soap and water. The area should also be thoroughly cleansed after all bowel movements to prevent infection. Experts no longer recommend using antimicrobial ointments around the catheter as they have not been shown to actually reduce infections. The person who has an indwelling catheter in place should increase fluid intake to 3,000 cc of fluid per day, unless there is a medical condition that prohibits this increase. Also, the drainage bag must always be lower than the bladder to prevent a backup of urine back up into the bladder. The drainage device should be emptied at least every eight hours or when the device is full. Care must be taken to keep the outlet valve from becoming infected. Wash your hands before and after handling the drainage device. Sometimes a low-dose antibiotic is given on a daily basis to control bacterial growth in people with indwelling catheters. Additionally, cranberry juice or vitamin C may be recommended to help prevent UTIs.

  

  Last revised: December 6, 2012
  by Dave R. Roger, M.D.
  
  

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