Catheter Acquired Urinary Tract Infection (CAUTI)

Scope

Managing suspected Catheter Acquired Urinary Tract Infection (CAUTI).

All adult men and non-pregnant adult women with an indwelling supra-pubic or urethral urinary catheter.

  • Dipstick urinalysis is not required
  • Don't treat asymptomatic CAUTI with antibiotics
  • If loin pain – consider renal calculi
  • Diagnosis is usually made clinically

Out of Scope

  • Children
  • Adults performing Clean Intermittent Catheterisation (CIC)
  • Pregnant women

Assessment

Signs and Symptoms

  • Pyrexia
  • Urgency/Bypassing and bleeding (this can also be a sign of bladder stones)
  • Loin pain
  • General malaise
  • Confusion
  • Offensive smelling and cloudy urine. NB changes in urine should not be considered in isolation or to be the driver for prescribing antibiotics as all indwelling catheters will have a biofilm of bacteria within hours of insertion resulting in asymptomatic bacteraemia

History and Examination

  • General history
  • Assess appearance of urine
  • Examine urethral meatus or supra-pubic site for evidence of inflammation, trauma or poor hygiene (this information should be available in community nurse records if catheter has been recently changed)
  • If loin pain experienced, consider renal stones and examine urine for grit

Differential Diagnosis

  • Systemic infection arising elsewhere (e.g. chest)
  • Renal colic
  • CAUTI associated with bladder stones

Red Flags

New frank haematuria - see guideline

Investigations

  • Catheter specimen of urine (CSU)
  • Dipstick urinalysis is not required (NICE QS90)

Management

Please see formulary guidance:

Chapter 5 - Urinary Tract Infections

Continence

Referral

Referral Criteria

Refer to urology if bladder stones or renal calculi suspected

Referral Instructions

e-Referral Service Selection

  • Specialty: Urology
  • Clinic Type: Urinary Calculus
  • Service: DRSS-South Devon & Torbay-Urology - Devon CCG - 15N

Referral Forms

DRSS referral form

Supporting Information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.

Publication Date: April 2019

 

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