Catheter-related UTI

Definition

A urinary tract infection, or “UTI,” is an infection that can occur in your kidneys, in the tubes that take urine from your kidneys to your bladder, or in your bladder.

You have an indwelling catheter (tube) in your bladder. "Indwelling" means inside your body. This catheter drains urine from your bladder into a bag outside your body.

• When you have an indwelling urinary catheter, you are more likely to develop a UTI. These infections are more likely if you have the catheter in place for a long time.
• Bacteria cause most UTIs that are related to having a catheter. A fungus called Candida can also cause UTIs.

Alternative Names

UTI - catheter associated; Urinary tract infection - catheter associated; Nosocomial UTI; Health care associated UTI; Catheter-associated bacteriuria

Causes

Many types of bacteria or fungi can cause a catheter-related UTI. In general, they are more resistant to common antibiotics than bacteria causing other types of UTIs.

Common reasons to have an indwelling catheter are:

• Urine leakage (incontinence)
• Not being able to urinate
• Surgery on your bladder, prostate, or vagina

During a hospital stay, you may have an indwelling catheter:

• Right after any type of surgery
• If you are very ill and cannot control your urine

Symptoms

• Abnormal urine color (cloudy urine)
• Blood in the urine (hematuria)
• Foul or strong urine odor
• Frequent and strong urge to urinate
• Pressure, pain, or spasms in your back or the lower part of your belly
• Leakage of urine around the catheter

Other symptoms that may occur with a UTI:

• 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.

Exams and Tests

Urine tests will check for infection:

• Urinalysis may show white blood cells (WBCs) or red blood cells (RBCs).
• Urine culture can help determine the type of bacteria in the urine and the appropriate antibiotic treatment.

Your doctor may recommend an ultrasound or CT exam of your urinary system.

Treatment

Because there is a risk that your infection may spread to your kidneys, antibiotics are almost always used to treat a UTI.

• Most of the time, you can take antibiotics by mouth. It is very important to take all of them, even if you feel better before you finish them.
• If your infection is more severe, you may need to receive antibiotics directly into your bloodstream. These will be given through an intravenous line, or IV.
• Besides antibiotics, you may also receive medicine to lessen bladder spasms.

Your catheter will need to be changed when you have a UTI.

You will need more fluids to help flush bacteria out of your bladder.

• If you are treating yourself at home, this may mean drinking 2 - 3 quarts of fluid a day, if your doctor says this is okay.
• Avoid fluids that irritate your bladder. Some of these are alcohol, citrus juices, and drinks that have caffeine in them.

After you have finished your treatment, you will have another urine test to make sure the bacteria are gone.

Outlook (Prognosis)

UTIs related to catheters can be harder to treat than other UTIs. Having many infections over time may lead to kidney damage or kidney stones and bladder stones.

If a UTI is not treated, you may develop kidney damage and more severe infections.

When to Contact a Medical Professional

Call your health care provider if you have:

• Any symptoms a urinary tract infection
• Back or flank pain
• Fever
• Vomiting

Prevention

If you have an indwelling catheter, you must do these things to help prevent infection:

• Clean around your urethra (where the catheter comes out) every day.
• Clean the catheter with soap and water every day.
• Clean your bottom thoroughly after every bowel movement.
• Always keep your drainage bag lower than your bladder so that the urine in the bag does not go back into your bladder.
• Empty the drainage bag at least every 8 yours, or whenever it is full.
• Have your indwelling catheter changed at least once a month.
• Wash your hands before and after you touch your urine.

Your health care provider might advise you to drink more fluids every day. This is not healthy for everyone, so talk with your doctor before you do this.

Your health care provider may prescribe a low-dose antibiotic to take every day to keep bacteria from growing in your catheter.

References

Fishman N, Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 290.

Hooton TM. Nosocomial urinary tract infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 304.

Infectious Disease Society ofAmerica.Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society ofAmerica. Clin Inf Dis. 2010;50:622-663.

Norrby SR. Approach to the patient with urinary tract infection.In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia,PA: Saunders Elsevier; 2011:chap 292.

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