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

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.

• 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

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

• A urinalysis may show 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.

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.

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 the patient finish all of prescribed antibiotics. Commonly used antibiotics include:

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

Medications to relax the bladder spasms (anti-cholinergics) 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 to 4,000 cc per day encourages frequent urination, which 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.

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.

• Chronic or recurrent urinary tract infection
• Complicated UTI
• Pyelonephritis

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 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.

Saint S. Biofilms and catheter-associated urinary tract infections. Infect Dis Clin North Am. 2003; 17(2): 411-32.

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