Catheter-related UTI

  • Definition
    • A catheter is a tube in your bladder that removes urine from the body. This tube may stay in place for an extended period of time. If so, it is called an indwelling catheter. The urine drains from your bladder into a bag outside your body.

      When you have an indwelling urinary catheter, you are more likely to develop a urinary tract infection (UTI) in your bladder or kidneys.

  • Alternative Names
    • UTI - catheter associated; Urinary tract infection - catheter associated; Nosocomial UTI; Health care-associated UTI; Catheter-associated bacteriuria; Hospital acquired-UTI

  • Causes
    • Many types of bacteria or fungi can cause a catheter-related UTI. This type of UTI is harder to treat with common antibiotics.

      Common reasons to have an indwelling catheter are:

      • Urine leakage (incontinence)
      • Not being able to empty your bladder
      • 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
  • 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. This will help your health care provider decide on the best antibiotic to use.

      Your provider may recommend:

      • Ultrasound of the abdomen
      • CT exam of the abdomen
  • Treatment
    • People who use this type of catheter will often have an abnormal test and culture of urine from the bag. But even if the test is abnormal, you may not have a UTI. This fact makes it harder for your provider to choose whether to treat you.

      If you also have symptoms of a UTI, your provider will likely treat you with antibiotics.

      If you do not have symptoms, your provider must consider other factors when deciding whether to treat you.

      However, 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 through an intravenous (IV) line. You may also receive medicine to lessen bladder spasms.

      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 to 3 quarts (1.9 to 2.9 liters) of fluid a day. You should ask your provider how much fluid is safe for you. Avoid fluids that irritate your bladder, such as alcohol, citrus juices, and drinks that contain caffeine.

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

      Your catheter will need to be changed when you have a UTI. If you have many UTIs, your provider may remove the catheter. The provider may also:

      • Ask you to insert a urine catheter intermittently so you don't keep one in all the time
      • Suggest other urine collection devices
      • Suggest surgery so you do not need a catheter
      • Use a special coated catheter that can reduce risk of infection
      • Prescribe a low-dose antibiotic or other antibacterial for you to take every day

      This can help prevent bacteria from growing in your catheter.

  • 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.

      Untreated UTI may develop kidney damage or more severe infections.

  • When to Contact a Medical Professional
  • Prevention
    • If you have an indwelling catheter, you must do these things to help prevent infection:

      • Clean around the catheter opening every day.
      • Clean the catheter with soap and water every day.
      • Clean your rectal area thoroughly after every bowel movement.
      • Keep your drainage bag lower than your bladder. This prevents the urine in the bag from going back into your bladder.
      • Empty the drainage bag at least once every 8 hours, 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.
  • References
    • Calfee DP. Prevention and control of health care-associated infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 282.

      Hooton TM. Nosocomial urinary tract infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 304.

      Nicolle LE, Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 284.