Definition, Etiology, PathogenesisTop
A single catheterization of the bladder is associated with a 1% to 3% risk of developing bacteriuria. The risk increases by 3% to 10% with every additional day the catheter remains in the bladder; after 30 days of continuous catheterization, the incidence of bacteriuria is almost 100%. Intestinal bacilli are the pathogens most commonly isolated from urine samples, but colonizations by Pseudomonas spp, Enterococcus spp, Staphylococcus spp, and fungi are also frequent. Since symptomatic urinary tract infection (UTI) is rare in patients with an indwelling urinary catheter and bacteriuria, it is not recommended to diagnose and treat asymptomatic bacteriuria in catheterized patients, as the resolution of bacteriuria is transient and followed by rapid selection of drug-resistant microorganisms. Usually, bacteriuria resolves spontaneously once the catheter has been removed; only <1% of patients develop symptomatic UTI. The most common signs and symptoms of UTI include fever, deterioration of the patient’s general condition, leukocytosis, bacteriuria >105 colony-forming units (CFU)/mL (frequently more than one pathogen is identified).
On the basis of urine culture results, use an antibiotic with as narrow an antibacterial spectrum as possible for 7 to 10 days in patients without bacteremia and for 10 to 14 days in patients with bacteremia.
Antibiotic prophylaxis in patients using clean intermittent self-catheterization may be beneficial in terms of reducing UTI recurrence rates over 12 months; however, emergence of antimicrobial resistance may preclude longer-term management using this approach. Antibiotics that can be considered include once-daily nitrofurantoin 50 mg, trimethoprim 100 mg, or 250 mg cephalexin [INN cefalexin].Evidence 1Weak recommendation (benefits likely outweigh downsides, but the balance is close or uncertain; an alternative course of action may be better for some patients). Moderate Quality of Evidence (moderate confidence that we know true effects of the intervention). Quality of Evidence lowered due to lack of blinding. Pickard R, Chadwick T, Oluboyede Y, et al. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Health Technol Assess. 2018 May;22(24):1-102. doi: 10.3310/hta22240. PubMed PMID: 29766842; PubMed Central PMCID: PMC5971229.
For other prevention strategies, see also Urinary Catheterization.