Pearl: CA-UTI is defined as the presence of a urinary catheter within past 48 hours of symptom onset, presence of signs or symptoms compatible with UTI, absence of other infectious source, and significant bacteriuria with one or more species. (IDSA CA-UTI guidelines)

The diagnosis of a CA-UTI requires the absence of other identified sources of infection. Here are signs and symptoms that are not attributable to UTIs (not exhaustive):

• CNS infection
  • Headache
  • Neck stiffness
  • Photophobia

• Respiratory tract infection
  • Sinus pain +/- purulent drainage
  • Rhinorrhea
  • Cough +/- production
  • Shortness of breath

• GI infection
  • Abdominal pain
  • Diarrhea
  • Jaundice
    
• Skin and soft tissue infection (SSTI)
  • Erythema
  • Pain
  • Warmth
  • Swelling
    
• Septic arthritis
  • SSTI symptoms
  • Restricted movement
  • Swollen, erythematous joint

Why can’t you just get a UA and culture immediately without considering other infectious causes?

• In long-term catheterized patients, all patients will be colonized with at least one bacterial species. Thus, checking a urinalysis and culture will certainly show bacteriuria. However, the presence of bacteria does not differentiate between asymptomatic bacteriuria (ASB) and a UTI (CA-UTI).

How do you differentiate between CA-ASB and CA-UTI?

The only way to differentiate is to rule out other infectious causes or have localizing symptoms to the urinary tract (flank pain, CVA tenderness, acute hematuria, pelvic discomfort) AND have the presence of significant bacteriuria.

• The presence, absence, of degree of pyuria should NOT be used! However, the absence of pyuria suggests a diagnosis other than a UTI.
• The presence or absence of odorous or cloudy urine alone should NOT be used because it is not specific!