Catheter-associated urinary tract infection in adults
- Thomas Fekete, MD
Thomas Fekete, MD
- Professor of Medicine and Microbiology
- Temple University School of Medicine
Urinary tract infections (UTI) associated with urinary catheters are the leading cause of secondary health care-associated bacteremia. Approximately 20 percent of hospital-acquired bacteremias arise from the urinary tract, and the mortality associated with this condition is about 10 percent .
Issues related to symptomatic UTI and asymptomatic bacteriuria in patients with indwelling bladder catheters will be reviewed here.
Issues related to asymptomatic bacteriuria and cystitis in other circumstances, and the indications for placement, methods of catheterization, and management and complications of bladder catheters are discussed separately. (See "Approach to the adult with asymptomatic bacteriuria" and "Acute uncomplicated cystitis and pyelonephritis in women" and "Acute uncomplicated cystitis and pyelonephritis in men" and "Placement and management of urinary bladder catheters in adults" and "Complications of urinary bladder catheters and preventive strategies" and "Acute complicated cystitis and pyelonephritis".)
Because the presence of bacteria in a urine sample may represent contamination by bacteria colonizing the periurethral area in addition to bladder bacteriuria, thresholds for bacterial growth from a urine sample that is likely to represent true bladder bacteriuria in specific contexts have been suggested by various expert groups. The Infectious Diseases Society of America (IDSA) guidelines define catheter-associated bacteriuria as follows :
●Symptomatic bacteriuria (urinary tract infection [UTI]) — Culture growth of ≥103 colony forming units (cfu)/mL of uropathogenic bacteria in the presence of symptoms or signs compatible with UTI without other identifiable source in a patient with indwelling urethral, indwelling suprapubic, or intermittent catheterization. Compatible symptoms include fever, suprapubic or costovertebral angle tenderness, and otherwise unexplained systemic symptoms such as altered mental status, hypotension, or evidence of a systemic inflammatory response syndrome.
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- Risk factors
- Spectrum of organisms
- Antimicrobial resistance
- CLINICAL FEATURES
- Symptoms and signs
- Laboratory findings
- General approach
- Specimen collection
- Antimicrobial therapy
- Catheter management
- ASYMPTOMATIC BACTERIURIA
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS