A catheter-associated urinary tract infection (CAUTI) is an infection of the urinary tract in a patient who has or recently had an indwelling urinary catheter. Bacteria climb along the tube, so the risk rises every day the catheter stays in.
Key symptoms
- Fever or chills with no other source
- Pain over the bladder or in the flank
- New confusion, mostly in older adults
- Cloudy or foul-smelling urine, or blood in the urine
What you find on exam
- Temperature, heart rate, blood pressure and breathing rate
- Tenderness above the pubic bone or at the flank
- Catheter check: date of insertion, closed system, bag below the bladder, no kinks
- Signs of sepsis: confusion, low pressure, poor perfusion
Tests
- Urinalysis and urine culture from the sampling port of a new catheter if possible
- Blood count, kidney function, lactate if sepsis is possible
- Blood cultures if febrile or unwell
- Do not test or treat urine without symptoms
Treatment basics
- Remove the catheter if no longer needed, or replace it before collecting the culture
- Antibiotics based on local resistance and culture, such as ceftriaxone, then narrow
- Usually 7 days of treatment if response is quick
- Fluids and sepsis care if unstable
- Prevention: catheter only when needed, sterile insertion, daily review of the need
Red flags
- Low blood pressure, fast heart rate or confusion
- Rigors or high fever with flank pain
- No urine draining or falling urine output
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Sources: AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back); Open RN, Nursing Skills 2e (Chippewa Valley Technical College); NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.