Catheter-associated UTI

Definition

Catheter-associated urinary tract infection (UTI) is an infection from using tubes (catheters) that drain urine from the body.

Alternative Names

UTI - associated with a catheter; Urinary tract infection - associated with a catheter

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 grow in it. A harmful infection may occur if the number of bacteria becomes large or if specific harmful bacteria grow in the urinary tract.

Symptoms

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

Other symptoms that may occur with this disease:

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

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

Signs and tests

• Urinalysis may show white blood cells (WBCs) or red blood cells (RBCs)
• Urine culture may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment

Treatment

Mild cases of acute UTI may disappear on their own without treatment. However, because of the risk of the infection spreading to the kidneys (complicated UTI), treatment is usually recommended.

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

MEDICATIONS

Antibiotics may be used to control the bacterial infection. It is very important that you finish all of your prescribed antibiotics. Commonly used antibiotics include:

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

Medications to relax the bladder spasms (anticholinergics) may also be given.

Phenazopyridine hydrochloride (Pyridium) may be used to reduce burning and urinary urgency.

SURGERY

Surgery is generally not needed for catheter-related urinary tract infection. However, chronic in-body catheters (Foley or suprapubic tube) should be changed every month. Proper sterile techniques must be used.

DIET

Increasing the amount of fluids to 2,000 - 4,000 cc per day encourages frequent urination. This flushes 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 you have symptoms of cystitis or a catheter-related UTI.

If you have cystitis, call if symptoms worsen or new symptoms develop, especially:

• Back or flank pain
• Fever
• 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 nonsterile catheter or using a nonsterile 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. Clean the area thoroughly 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.

Increase fluid intake to 3,000 cc of fluid per day, unless you have a medical condition that prohibits this increase. Also, always keep the drainage bag lower than the bladder to prevent a backup of urine into the bladder.

Empty the drainage device at least every 8 hours or when it is full. Take care to keep the outlet valve from becoming infected. Wash your hands before and after handling the drainage device.

Your health care provider may prescribe a daily low-dose antibiotic to control bacterial growth in an indwelling catheter. Cranberry juice or vitamin C may also be recommended to help prevent UTIs.

References

Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am. 2003;17(2):411-432.

Walsh PC, ed. Campbell's Urology. 8th ed. St. Louis, Mo: WB Saunders; 2002:1863.

Moore KN, Fader M, Getliffe K. Long-term bladder management by intermittent catheterisation in adults and children. Cochrane Database Syst Rev. 2007;4:CD006008.