Pearl: The evaluation for UTI is very different in CA-UTI compared to non-CA-UTIs.  This is because catheters have different symptom presentations, baseline rates of bacteriuria, and organisms to consider.

A critical decision-making branch point is determining if there is suspicion for a catheter associated-UTI by evaluating if the patient had a urinary catheter* in place for >48 hours before the onset of symptoms.

• *There is debate about what type of catheter qualifies for CA-UTI with some guidelines requiring a urethral catheter only whereas others include condom, suprapubic, and intermittent catheterization

Comparison for CA-UTI vs non- CA-UTI:

• Urinary catheters have bacterial colonization approaching 100% after 1 month so testing the urine for the presence of bacteria is very low yield
• The evaluation for a CA-UTI is more focused on evaluating for other etiologies since many localizing symptoms are not present with a catheter (urgency, dysuria, frequency)
• CA-UTI are more likely polymicrobial, increased antibiotic resistance, and generally require longer duration of therapy