Acute urinary tract infection – catheter-associated (Antimicrobial)

In catheterised patients, only send urine samples for laboratory culture if the patient has clinical signs and symptoms of urinary tract origin, not because the appearance or smell of the urine suggests that bacteriuria is present.  All catheterised patients will have abnormal urinalysis therefore dipstick urinalysis is unnecessary and unreliable (RCN Catheter Care Guide).  The Scottish Antimicrobial Prescribing Group has developed a decision aid for the diagnosis and management of suspected urinary tract infection in people with indwelling catheters to assist nursing and care staff and prescribers to manage catheterised patients with urinary tract infection.  A flow chart for care home staff on assessing older people for urinary tract infection is available and recommended.  Discuss management of post-joint replacement patients with Microbiology.  Use of the National Catheter Passport is recommended to improve communication and reduce the risk of infection.

Send urine for culture only if infection strongly suspected and include symptom details (not dipstick results) on the Microbiology request form. See RCN Catheter Care Guidelines.

Treat as lower urinary tract infection if there is no fever or flank pain.  Duration is 7 days regardless of gender.

If fever or back pain or other systemic signs of infection are present, treat as upper urinary tract infection (pyelonephritis/urosepsis).