Catheter Associated Asymptomatic Bacteriuria and Urinary Tract Infections - Is there a need for prophylactic antibiotics?

Some Facts:

• Catheter associated- bacteriuria accounts for 40% of hospital acquired infections
• Symptomatic UTI is less common than respiratory and skin/soft tissue infections
• Not surprisingly most patients with long term indwelling catheters are bacteriuric. However, the majority of patients who are managed with intermittent catheterization are also bacteriuric;
• The incidence of bacteriuria associated with indwelling catheter is 3-8% per day
• Study performed on trauma patients (n=510) showed that fever and leukocytosis was not associated with catheter associated bacteriuria 
• Evidence of UTI in a catheterized patient:
• New onset costovertebral tenderness
• Rigors
• New onset delirium
• Fever, leukocytosis, foul smelling/cloudy urine and urinary complaints in catheterized patients have poor predictive value
• Catheterized patients with concern for infection should be thoroughly evaluated for other sources before attributing their presentation to a UTI.

Recommendation from American Urological Association through the Choosing Wisely initiative:

“Systemic antimicrobial prophylaxis should not be routinely used in patients with short-term (A-III) or long-term (A-II) catheterization, including patients who undergo surgical procedures, to reduce CA-bacteriuria or CA-UTI because of concern about selection of antimicrobial resistance.”

Evidence:

• Systemic antimicrobial therapy has been shown to reduce and postpone the development of catheter associated bacteriuria for the first 4 days of catheterization
• Rates become similar after 4 days of catheterization
• Some have suggested use of antibiotics in patients who are at high risk of developing serious complications if UTI occurs, such as patient with neutropenia, who underwent to urological procedure or procedure involving foreign body, but no studies have been preformed in these patient populations

References

Diagnosis, prevention, and treatment of Catheter-Associated Urinary Tract Infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America [Internet]. Arlington (VA): Infectious Diseases Society of America; 2010 [cited 2014 Nov 4]. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/650482.