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What are the criteria for treating a catheter-associated urinary tract infection?

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A catheter-associated urinary tract infection (CAUTI) is diagnosed only when signs and symptoms of an infection coexist with evidence of bacteriuria (> 100,000 colony-forming units per ml [CFU/ml] and a host response to the presence of bacteriuria [diagnosed on urinalysis as pyuria]).

Asymptomatic bacteriuria is not routinely treated in the catheterized patient, regardless of whether it occurs in the critical care unit, inpatient hospital unit, or long-term care facility. Treatment should not occur even when asymptomatic bacteriuria coexists with pyuria. Patients with indwelling urinary catheters typically develop pyuria because of the inflammation associated with the presence of the catheter itself. Asymptomatic bacteriuria is treated only in highly selected cases, such as patients undergoing certain abdominopelvic or urologic procedures, or selected immunocompromised patients.

Signs and symptoms of a CAUTI include the presence of two or more of the following:

  • Fever (> 2.0°F or > 1.1°C)
  • Flank, abdominal, or suprapubic tenderness
  • Change in urine character
  • Hematuria
  • Sudden change in mental or functional status

--Mikel L. Gray, PhD, CUNP, CCCN, FAANP, FAAN

(September 2009)