PEARL: CA-UTI is defined as the presence of a urinary catheter for >48 hours, presence of signs or symptoms compatible with UTI, absence of other infectious source, and significant bacteriuria with one or more species

Monitoring:

• Patients should improve in 48-72 hours.
  • Failure to improve should prompt evaluation for complicating factors (obstruction, instrumentation, impaired voiding, metabolic abnormalities, immunocompromised states)
  • Consider further evaluation such as CT A/P or renal US to rule out or evaluate for perinephric abscess
• Deescalate/narrow antibiotics based on susceptibilities from urine culture

Prophylaxis (IDSA 2009 CA-UTI Guidelines: 29-38):

• Best prophylaxis is removing catheter (if possible). In general, condom > indwelling; intermittent catheterization > indwelling; suprapubic > indwelling in short term (insufficient in long term); suprapubic vs intermittent unclear
• Systemic antibiotics should not be routinely used to due acquired resistance
• Methenamine salt should not be routinely used other than catheters for <1 week
• Cranberry should not be routinely used in neurogenic bladder, insufficient data for other catheter groups
• Meatal care is not recommended
• Cath irrigation with antimicrobials or normal saline should not be routinely used