Catheter Associated Urinary Tract Infections ( CAUTI ) in adults ( ≥ 16 years of age ) - Guideline for the management of in secondary care

Publication: 22/10/2013  --
Last review: 14/08/2020  
Next review: 14/08/2023  
Clinical Guideline
CURRENT 
ID: 3504 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Catheter Associated Urinary Tract Infections (CA-UTI) in Adults

NICE defines CA-UTI as the presence of symptoms or signs compatible with a UTI in people with a catheter with no other identified source of infection plus significant levels of bacteria in a catheter or a midstream urine specimen when the catheter has been removed within the previous 48 hours.

Signs and symptoms include fever >38ºC, suprapubic tenderness, or otherwise unexplained systemic symptoms such as altered mental status. These patients may also have dysuria and/or urinary urgency/ frequency in addition to the symptoms listed above.

DIAGNOSTICS

Whilst CA-UTI is ultimately a clinical diagnosis, appropriate sampling allows appropriately directed treatment.

All SYMPTOMATIC patients

Do NOT dipstick

Cloudy or smelly urine, without clinical signs and symptoms, is not an indication for culture

Catheter Specimen Urine (CSU) with details of symptoms taken prior to antibiotics being given.

Patients who require IV antibiotics

Refer to the  Upper UTI guideline
Blood cultures will need to be taken prior to starting antibiotic

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EMPIRICAL TREATMENT (renal dose adjustment may be required)

  • Do NOT treat asymptomatic bacteriuria or pyuria
  • Remove catheter if it is no longer needed or change after 48 hours of oral antibiotics if infection suspected
  • In patients with bladder emptying dysfunction, clean intermittent catheterisation (CIC) is the preferred management option.
  • If your patient has had a recent urine culture, please use the sensitivity results to provide directed therapy (see table for order of preference).
  • Notes on empirical options:
    • Doses assume normal renal and hepatic function
    • Not all antibiotics in this guideline are suitable in all stages of pregnancy.

Empirical options for CA-UTI with no signs of sepsis or concomitant upper UTI

 

Recommended treatment

Notes

Duration

1st line

Nitrofurantoin PO 50mg
6-hourly

Do not use if CrCl <45 mL/min. Do not rely on eGFR as this may over-estimate renal function.
Avoid liquid -consider fosfomycin sachets as an alternative.

7 days

2nd line

Pivmecillinam PO 400mg stat then 200mg 8-hourly

Avoid in penicillin allergy

3rd line

Fosfomycin PO 3g stat and repeated at 72 hours

Do not use if CrCl <10mL/min

IV antibiotics are not normally required for CA-UTI.  If there are signs of sepsis, concomitant upper UTI, or unable to take oral medication then please refer to the Upper UTI guideline

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REVIEW BY 72 HOURS

By 72 hours of antibiotic treatment, diagnostics should have proven your initial diagnosis or guided to a new diagnosis.
You should document the outcome of the review in the medical notes.

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DIRECTED THERAPY

Stop

If no signs of infection and diagnostics support this decision.

Change

  • If diagnosis still valid, use culture results to review current antibiotic and change to directed therapy if needed.
  • If initial diagnosis now changed - review appropriate guideline.

Continue

If already on a narrow spectrum agent and improving.

IVOS

Please refer to the Upper UTI guideline for oral switch options if your patient was started on IV antibiotics for signs of sepsis or concomitant upper UTI.
If your patient is on IV antibiotics they should be reviewed daily.

The table below is in order of preference based on culture results.

  • Doses assume normal renal and hepatic function.
  • Not all antibiotics in this guideline are suitable in all stages of pregnancy. Please refer to the UTI in pregnancy guidelines

 

Treatment

Notes

Duration of treatment: 7 days in total of effective antibiotics.

1

Nitrofurantoin PO 50mg 6-hourly

Do not use if CrCl <45 mL/min. Do not rely on eGFR as this may over-estimate renal function.

2

Trimethoprim PO 200mg 12-hourly 

 

3

Amoxicillin PO 500mg 8-hourly

Avoid in penicillin allergy

4

Pivmecillinam PO 400mg stat then 200mg 8-hourly

Avoid in penicillin allergy

5

Co-trimoxazole PO 960mg 12-hourly

 

6

Cefalexin PO 500mg 8-hourly

Avoid in penicillin allergy
Avoid in >65 year olds
C.difficile risk

7

Fosfomycin PO 3g stat, repeated at 72 hours

Avoid if CrCl <10mL/min

8

Ciprofloxacin1 PO 500mg 12-hourly

MHRA warning1. Patients must be warned of potential musculoskeletal and nervous system side effects. 
C. difficile risk.

9

Co-amoxiclav (Amoxicillin-clavulanate) PO 625mg 8-hourly

Avoid in penicillin allergy
C. difficile  risk

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FOOTNOTES

  1. See MHRA advice for restrictions and precautions for using fluoroquinolone antibiotics due to very rare reports of disabling and potentially long-lasting or irreversible side effects affecting musculoskeletal and nervous systems. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding co-administration with a corticosteroid (March 2019).

Provenance

Record: 3504
Objective:
Clinical condition:

Catheter Associated Urinary Tract Infections

Target patient group: Adults >16 years
Target professional group(s): Secondary Care Doctors
Pharmacists
Adapted from:

Evidence base

  • Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63
  • Diagnosis of urinary tract infections: Quick reference tool for primary care for consultation and local adaption, Public Health England, version 2, latest update Sept 2019.
  • Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54
  • SIGN 88: Management of suspected bacterial urinary tract infection in adults (accessed April 2020) https://www.sign.ac.uk/media/1051/sign88.pdf
  • NICE 113: Urinary tract infection (catheter-associated): antimicrobial prescribing (accessed April 2020) https://www.nice.org.uk/guidance/ng113

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 3.0

Related information

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