Guidelines on Urological Infections. European Association of Urology. Accessed November 2, 2021. https://uroweb.org/guideline/urological-infections
Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68(10):e83-e110. doi: 10.1093/cid/ciy1121. PMID: 30895288.
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257. Review. PubMed PMID: 21292654.
Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63. PubMed PMID: 20175247.
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 14 days, depending on clinical resolution.
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.