Catheter-associated urinary tract infection in adults

Author:
Thomas Fekete, MD
Section Editor:
Stephen B Calderwood, MD
Deputy Editor:
Allyson Bloom, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Apr 2020. | This topic last updated: Mar 05, 2020.

INTRODUCTION Urinary catheters are placed for a number of reasons,

including diagnostic and therapeutic reasons, as well as for convenience. The presence
of a catheter increases the risk of bacteriuria, which can be clinically benign or progress
to serious infection. There is an overall lack of consensus about the optimal approach to
catheter-associated urinary tract infections (UTIs), apart from removing catheters when
no longer necessary.

Issues related to symptomatic UTI and asymptomatic bacteriuria in patients with

indwelling bladder catheters will be reviewed in this topic.

Issues related to asymptomatic bacteriuria and cystitis in other circumstances, and the
indications for placement, methods of catheterization, and management and
complications of bladder catheters are discussed separately. (See "Asymptomatic
bacteriuria in adults" and "Acute simple cystitis in women" and "Acute simple cystitis in
men" and "Placement and management of urinary bladder catheters in
adults" and "Complications of urinary bladder catheters and preventive
strategies" and "Acute complicated urinary tract infection (including pyelonephritis) in
adults".)

DEFINITIONS Because the presence of bacteria in a urine sample may

represent contamination by bacteria colonizing the periurethral area in addition to

bladder bacteriuria, thresholds for bacterial growth from a urine sample that is likely to
represent true bladder bacteriuria in specific contexts have been suggested by various
expert groups. The Infectious Diseases Society of America (IDSA) guidelines define
catheter-associated bacteriuria as follows [1]:
●Symptomatic bacteriuria (urinary tract infection [UTI]) – Culture growth
of ≥103 colony forming units (cfu)/mL of uropathogenic bacteria in the
presence of symptoms or signs compatible with UTI without other identifiable
source in a patient with indwelling urethral, indwelling suprapubic, or
intermittent catheterization. Compatible symptoms include fever, suprapubic
or costovertebral angle tenderness, and otherwise unexplained systemic
symptoms such as altered mental status, hypotension, or evidence of a
systemic inflammatory response syndrome.
●Asymptomatic bacteriuria – Culture growth of ≥105 cfu/mL of
uropathogenic bacteria in the absence of symptoms compatible with UTI in a
patient with indwelling urethral, indwelling suprapubic, or intermittent
catheterization.
Patients who are no longer catheterized but had urethral, suprapubic, or condom
catheters within the past 48 hours are also considered to have catheter-associated UTI
or asymptomatic bacteriuria if they meet these definitions.

Because periurethral contamination is less likely in catheterized specimens, a relatively

low threshold for bacteria growth in a symptomatic patient is likely to represent true
bladder bacteriuria. Although the IDSA guidelines acknowledge that growth as low as
102 cfu/mL has been associated with bladder bacteriuria in the setting of symptoms, the
threshold of 103 cfu/mL was chosen since many labs do not quantify growth below that
threshold.

In contrast, use of a higher threshold in asymptomatic patients is reasonable given the

low rate of complications is this setting and the desire for increased specificity to reduce
the overuse of antimicrobials, even if bacterial growth does represent bladder
bacteriuria. (See 'Asymptomatic bacteriuria' below.)

These definitions are different from those used by the United States Centers for
Disease Control and Prevention (CDC) National Health Safety Network (NHSN), which
were created for surveillance purposes, not specifically for clinical care [2]. The NHSN
uses the same basic definition for asymptomatic bacteriuria but defines catheter-
associated UTI as the presence of fever, suprapubic tenderness, or costovertebral
angle pain in the setting of urine culture with bacterial counts ≥10 5 cfu/mL of no more
than two organism species (and does not include fungal isolates or minor pathogens).
The NHSN definition does not allow for other attribution of fever, so it may overestimate
the rate of clinically relevant catheter-related bacteriuria [3]. Furthermore, because the
NHSN definition sometimes changes, it can be difficult to compare infection rates
across time. As an example, one hospital-based study noted that the measured
infection rate as determined retroactively by the updated definition fell by half compared
with the rate reported using the old definition [4].

The NHSN definitions also make attempts to distinguish between hospital-acquired and
pre-existing UTIs in order to allow attribution to the institution where the urine was
collected or to another facility.

EPIDEMIOLOGY

Incidence — Bacteriuria in patients with indwelling bladder catheters occurs at a rate of

approximately 3 to 10 percent per day of catheterization [5,6]. Of those with bacteriuria,
10 to 25 percent develop symptoms of urinary tract infection (UTI) [7-9].

This translates into a substantial burden of catheter-associated UTIs in hospitalized

patients. In the United States, based on surveillance data reported to the CDC National
Healthcare Safety Network, the incidence of catheter-associated UTIs in 2012 was 1.4
to 1.7 per 1,000 catheter days in inpatient adult and pediatric medical/surgical floors
[10].

Risk factors — The duration of catheterization is an important risk factor for catheter-

associated bacteriuria and UTI and is a major target of prevention efforts [11,12].
(See 'Prevention' below.)

Other risk factors include [13-15]:

 ●Female sex
●Older age
●Diabetes mellitus
●Bacterial colonization of the drainage bag
●Errors in catheter care (eg, errors in sterile technique, not maintaining a
closed drainage system, etc.)

PATHOGENESIS Urinary tract infection (UTI) associated with catheterization

may be extraluminal or intraluminal. Extraluminal infection occurs via entry of bacteria

into the bladder along the biofilm that forms around the catheter in the urethra [16-19].
Intraluminal infection occurs due to urinary stasis because of drainage failure, or due to
contamination of the urine collection bag with subsequent ascending infection.
Extraluminal is more common than intraluminal infection (66 versus 34 percent in one
study) [20].

Rarely, there can be purple discoloration of the urine, collecting bag, and tubing (the
purple urine bag syndrome) [21]. The purple color of the urine is due to metabolic
products of biochemical reactions formed by bacterial enzymes in the urine.
Gastrointestinal tract flora break down the amino acid tryptophan into indole, which is
subsequently absorbed into the portal circulation and converted into indoxyl sulfate.
Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl
if the appropriate alkaline environment and bacterial enzymes (indoxyl sulfatase and
indoxyl phosphatase) are present. The breakdown products, indigo and indirubin,
appear blue and red, respectively [22,23]. Bacteria capable of producing these enzymes
include Providencia spp, Klebsiella, and Proteus.

MICROBIOLOGY

Spectrum of organisms — The causative pathogens in catheter-associated urinary

tract infection (UTI) and asymptomatic bacteriuria are similar to those that are
associated with complicated UTI in general. Specifically, Escherichia coli and other
Enterobacteriaceae are common, but Pseudomonas aeruginosa, enterococci,
staphylococci, and fungi are also significant causes. (See "Acute complicated urinary
tract infection (including pyelonephritis) in adults", section on 'Microbiology'.)

As an example, of approximately 154,000 catheter-associated UTIs reported by acute

care hospitals and long-term acute care facilities to the US National Healthcare Safety
Network (NHSN) between 2011 and 2014, the most common causative pathogens
identified were [24]:

●E. coli — present in 24 percent of cases

●Candida spp (or yeast, not otherwise specified) — 24 percent
●Enterococcus spp — 14 percent
●P. aeruginosa — 10 percent
●Klebsiella spp — 10 percent

Ambulatory patients with indwelling catheters tend to acquire urinary bacteria similar to
those found in hospitalized patients rather than the types usually seen in the outpatient
setting. Prolonged catheterization can be associated with polymicrobial bacteriuria or
changing urinary flora.

Some of these organisms associated with catheter-related bacteriuria or funguria may

lack some of the virulence factors that allow the usual uropathogens to adhere to
uroepithelium, but they take advantage of easy access to the bladder via the catheter. A
good example of such an organism is Candida spp, which almost never cause UTI in
the absence of an indwelling catheter. In contrast, candiduria is a common finding in
patients with indwelling bladder catheters, particularly in those who are taking
antimicrobials or are diabetic [25]. However, most patients are asymptomatic, funguria
merely represents colonization, and progression to candidemia is uncommon (1.3
percent in one series) [25]. This problem is discussed in detail separately.
(See "Candida infections of the bladder and kidneys", section on 'Infection versus
colonization'.)

Antimicrobial resistance — Organisms that cause catheter-associated UTI and

asymptomatic bacteriuria are increasingly resistant to antimicrobial agents.

Of the 10,800 E. coli catheter-associated isolates reported to the US NHSN in 2014, 35

percent were resistant to fluoroquinolones, and 16 percent to advanced generation anti-
pseudomonal cephalosporins (ie, cefepime and ceftazidime) [24]. Of
4700 Klebsiella isolates, 9.5 percent were resistant to carbapenems.

CLINICAL FEATURES

Symptoms and signs — Symptoms of catheter-associated urinary tract infection (UTI)

are protean and do not necessarily refer to the urinary tract. Fever is the most common
symptom [1,7,26]. Localizing symptoms may include flank or suprapubic discomfort,
costovertebral angle tenderness, and catheter obstruction. However, many catheterized
patients without evidence of UTI or even bacteriuria may have similar symptoms. As an
example, in an observational study that included 89 hospitalized patients who
developed bacteriuria following placement of a urethral catheter, 18 percent had a
temperature >38.5 C (101.3 F), 6 percent had dysuria, and 6 percent had urinary
urgency [7]. These symptoms were present in the same proportion of 945 catheterized
patients without bacteriuria.

Patients with spinal cord injury may have especially atypical and nonspecific symptoms,
including increased spasticity, malaise/lethargy, and autonomic dysreflexia. Individuals
who develop UTI soon after removal of a catheter may be more likely to have the typical
urinary symptoms of dysuria, frequency, and urgency.

Many patients believe that a cloudy appearance or foul smell of the urine is suggestive
of the presence of a UTI. However, neither of these findings has been demonstrated to
be clearly associated with either bacteriuria or a UTI [1,26].

Rarely, purple discoloration of the urine, collection bag, and tubing (purple urine bag
syndrome [PUBS]) can occur due to metabolic byproducts of certain bacteria that may
be present in the system [21]. Risk factors include bacteriuria, constipation, and female
gender. PUBS is benign and has not been demonstrated to have any implication other
than the possibility of a UTI. (See 'Pathogenesis' above.)
Laboratory findings — Pyuria is a common finding in catheterized patients with
bacteriuria, whether they are symptomatic (ie, have UTI) or not. However, in a series of
761 catheterized patients, quantitative urine WBC >10 cells/microL had low sensitivity
for predicting growth of >105 colony forming units (cfu)/mL (47 percent) [27]. Specificity,
on the other hand, was 90 percent. The vast majority of these patients had no
symptoms attributable to UTI.

By definition, all patients with catheter-associated UTI have bacteriuria or funguria. The
vast majority of patients with symptomatic bacteriuria (ie, UTI) have bacterial culture
growth ≥105 cfu/mL or fungal growth in urine, although occasionally bacterial counts as
low as 102 cfu/mL have also been described in individuals with UTI in the absence of a
catheter [28,29]. The frequency of low count bacteriuria in the setting of catheter-
associated UTI is not clearly defined but expected to be very low [1,26]. The spectrum
of associated pathogens is discussed elsewhere. (See 'Spectrum of organisms' above.)

DIAGNOSIS

General approach — The diagnosis of a catheter-associated UTI is made by the

finding of bacteriuria in a catheterized patient who has signs and symptoms that are
consistent with UTI or systemic infection that are otherwise unexplained. A UTI
diagnosed in a patient who had a catheter removed within the past 48 hours is also
considered a catheter-associated UTI. (See 'Definitions' above.)

Consistent findings may be specific to the urinary tract (eg, costovertebral angle
tenderness) or may be more general, such as fever, leukocytosis, fall in blood pressure,
metabolic acidosis, or respiratory alkalosis. If the diagnosis is based on such
nonspecific findings, the evaluation should rule out the possibility of other infections (eg,
bacteremia, pneumonia, skin or soft tissue infection) prior to attributing them to a
catheter-associated UTI.

Because the symptoms and signs of catheter-associated UTI can be nonspecific, a fair
amount of clinical judgment and individualization is required. Older or debilitated
patients often present with nonspecific signs or symptoms, such as falls, change in
functional status, and change in mental status. Because older catheterized patients
often have bacteriuria, these findings have traditionally been attributed to UTI in such
patients. However, growing evidence indicates that these are not reliable predictors of
bacteriuria or UTI, and treatment for bacteriuria does not improve these symptoms [30-
32]. Thus, we do not routinely test urine in such patients in the absence of focal urinary
tract symptoms or systemic signs of infection (eg, fever), and instead hydrate, correct
metabolic abnormalities, and assess other potential contributing factors.
(See "Approach to infection in the older adult", section on 'Urinary tract infection'.)

The vast majority of patients with catheter-associated UTI have counts ≥10 5 cfu/mL.
Thus, when the level of bacteriuria is lower, other potential explanations for the
presenting symptoms should be evaluated before diagnosing a catheter-associated UTI,
particularly if the symptoms are nonspecific or the isolated organisms are not
Enterobacteriaceae.

Certain findings, such as pyuria and the appearance or smell of the urine, should not be
used to diagnose a UTI when found in isolation. Pyuria is frequently found in
catheterized patients with bacteriuria, whether they have symptoms or not, and odorous
or cloudy urine has not been demonstrated to be indicative of either bacteriuria or UTI.
On the other hand, the absence of pyuria in a symptomatic catheterized patient
suggests a diagnosis other than UTI. (See 'Clinical features' above.)

Specimen collection — Ideally urine samples for culture should be obtained by

removing the indwelling catheter and obtaining a midstream specimen. If ongoing
catheterization is needed, the catheter should be replaced prior to collecting a urine
sample for culture, to avoid culturing bacteria present in the biofilm of the catheter but
not in the bladder.

Many systems have a "needleless" site that can be cleansed prior to specimen
collection. If a sample is being collected without catheter removal, urine should be
obtained from the port in the drainage system (figure 1) [33]. For circumstances in which
the above approaches are not possible, the culture should be obtained by separating
the catheter from the drainage system. Although this approach is associated with some
risk of introducing microbes into the closed system, culture results from urine collected
from the drainage bag cannot be used to guide treatment.

In the setting of condom catheters, it can be difficult to distinguish true infection from
skin and mucosal contamination [17,34]. In these cases, a clean catch midstream
specimen should be obtained, or urine should be collected from a freshly applied
condom catheter after cleaning the glans [34]. (See "Sampling and evaluation of voided
urine in the diagnosis of urinary tract infection in adults".)

TREATMENT The approach to treatment of catheter-associated urinary tract

infection (UTI) includes antimicrobial therapy and catheter management.

Antimicrobial therapy — The approach to empiric antimicrobial therapy for patients

with catheter-associated UTI depends in part on the presentation and whether there are
features that suggest an infection that has extended beyond the bladder (which we use
to distinguish acute complicated UTI from acute simple cystitis). Most patients with
catheter-associated UTI come to clinical attention because of fever, flank pain,
costovertebral angle tenderness, or systemic signs or symptoms of infection in the
setting of pyuria and bacteriuria; such cases are consistent with acute complicated UTI
and are managed as such. (See "Acute complicated urinary tract infection (including
pyelonephritis) in adults", section on 'Management'.)

Some patients, in particular those who have recently had catheter removal, present with
isolated symptoms of cystitis (eg, dysuria, urinary frequency or urgency) in the absence
of fever or features of ascending infection or prostatitis. Such patients can be managed
as having acute simple cystitis. (See "Acute simple cystitis in women" and "Acute
simple cystitis in men".)

Antibiotic selection for both acute complicated UTI and acute simple cystitis takes into
account risk factors for resistant infection (informed by past urine cultures, use of
antimicrobial therapy, health care exposures, community prevalence of antimicrobial
resistance) and antibiotic allergies.

Once culture and susceptibility results are available, the antimicrobial regimen should
be tailored to the specific organism isolated. The approach to management
of Candida UTIs is discussed elsewhere. (See "Candida infections of the bladder and
kidneys", section on 'Treatment'.)

The optimal duration of therapy is uncertain. Depending on the clinical response, the
infecting organism, and the agent used for treatment, 7 to 14 days of therapy is
generally appropriate (with use of the longer end of this range for patients who respond
slowly) [1]. Oral therapy can be used for some or all of the treatment course if the
organism is susceptible and the patient is well enough to take oral medication with
adequate absorption.

Catheter management — The optimal approach to catheter management in the setting

of urinary tract infection (UTI) is uncertain, although minimization of the use of
indwelling catheters, when possible, is preferred. In general, patients who no longer
require catheterization should have the catheter removed and receive appropriate
antimicrobial therapy [35,36]. Patients who require extended catheterization should be
managed with intermittent catheterization, if possible. (See "Placement and
management of urinary bladder catheters in adults", section on 'Catheter
removal' and "Placement and management of urinary bladder catheters in adults",
section on 'Clean intermittent catheterization'.)

Intermittent catheterization is associated with a lower rate of bacteriuria and UTI than
long term indwelling catheterization [37]. If long term catheterization is needed and
intermittent catheterization is not feasible, the catheter should be replaced at the
initiation of antimicrobial therapy [38]. Catheter replacement is associated with fewer
and later relapses than retaining the original catheter, as biofilm penetration of most
antimicrobials is poor [39].

COMPLICATIONS Important complications of catheter-associated urinary

tract infections (UTIs) include sepsis, bacteremia, and involvement of the upper urinary
tract.

Approximately 20 percent of health care-associated bacteremias arise from the urinary

tract, and the mortality associated with this condition is about 10 percent [40]. In the
intensive care unit setting, a lower proportion of bacteremia is attributable to catheter-
associated UTIs [1].

Upper tract infection is another important consequence of catheter associated urinary

tract infection. In an autopsy series of 75 nursing home patients, the incidence of renal
parenchymal inflammation was higher in those with a catheter in place at the time of
death than in those who were not catheterized (38 versus 5 percent) [41]. The
implications of this finding are not known.

ASYMPTOMATIC BACTERIURIA Bacteriuria in the absence of

symptoms is very common among catheterized patients [7]. Treatment of asymptomatic

bacteriuria does not affect patient outcomes, including the risk of complications and or
the subsequent development of UTI symptoms, and increases the likelihood of
emergence of resistant bacteria [1,42,43]. Thus, with few exceptions, screening and
treatment for asymptomatic bacteriuria in catheterized patients is not indicated.
(See "Asymptomatic bacteriuria in adults", section on 'Rationale for not treating'.)

Evaluating for asymptomatic bacteriuria in patients with indwelling catheters is

warranted only in the setting of pregnancy or prior to urologic procedures for which
mucosal bleeding is anticipated because of very specific risks of bacteriuria in these
particular populations. (See "Urinary tract infections and asymptomatic bacteriuria in
pregnancy", section on 'Asymptomatic bacteriuria' and "Asymptomatic bacteriuria in
adults", section on 'Patients undergoing urologic intervention'.)

PREVENTION In general, the most important aspects of prevention of

catheter-associated urinary tract infections (UTI) are avoidance of unnecessary

catheterization, use of sterile technique when placing the catheter, and removal of the
catheter as soon as possible. As an example, in a nationwide prospective study in the
United States, implementing initiatives to reinforce these concepts was associated with
a decline in the baseline rate of catheter-associated UTIs in non-intensive care units
[44]. Similarly, in a Canadian study, there was a modest but sustained reduction in post-
operative UTI with a standardized approach to perioperative bladder catheterization that
followed these principles [45].

There is no clear benefit to using either antibiotic-coated urinary catheters or

prophylactic antibiotics to reduce the risk of catheter associated urinary tract infection.
These and other issues related to catheter care for prevention of UTI are discussed in
detail separately. (See "Placement and management of urinary bladder catheters in
adults", section on 'Catheter care' and "Placement and management of urinary bladder
catheters in adults", section on 'To prevent urinary tract infection' and "Placement and
management of urinary bladder catheters in adults", section on 'Catheter
removal' and "Placement and management of urinary bladder catheters in adults",
section on 'Prophylactic antibiotics'.)

RECOMMENDATIONS OF OTHERS Several expert and governmental

groups have released guidelines or recommendations on the identification,

management, and prevention of catheter associated urinary tract infections (UTIs)
[1,12,40,46]. All of them stress restricting the use of indwelling catheters and those that
address treatment recommend avoidance of unnecessary antimicrobial use for
asymptomatic bacteriuria.

The Infectious Diseases Society of America (IDSA), in collaboration with other

international expert groups, released practice guidelines on the diagnosis, prevention,
and treatment of catheter-associated UTI in 2009 [1]. The discussion in this topic is
generally consistent with those guidelines.

In 2014, a collaborative panel sponsored by the Society for Healthcare Epidemiology of

America (SHEA) released recommendations on the prevention of catheter-associated
UTI [12]. This publication highlighted the importance of the judicious use of urethral
catheters only for appropriate indications, adequate expertise and sterile technique for
insertion, continued assessment of the necessity of catheterization, and maintenance of
a sterile, continuously closed drainage system that allows unobstructed urine flow.
 SOCIETY GUIDELINE LINKS Links to society and government-sponsored

guidelines from selected countries and regions around the world are provided
separately. (See "Society guideline links: Urinary tract infections in adults".)

SUMMARY AND RECOMMENDATIONS

●Catheter-associated urinary tract infections (UTIs) are a common health

care-associated infection. Bacteriuria in patients with indwelling bladder
catheters occurs at a rate of approximately 3 to 10 percent per day of
catheterization. Of those with bacteriuria, approximately 10 to 25 percent
develop UTI. The most important risk factor is the duration of catheterization.
Other risk factors include errors in catheter care. (See 'Epidemiology' above.)
●Fever is the most common symptom of catheter-associated UTI. Pyuria is
usually present. Localizing symptoms may include flank or suprapubic
discomfort, costovertebral angle tenderness, and catheter obstruction.
However, these symptoms are not specific to UTI and may be seen in
catheterized patients without bacteriuria. Pyuria is also common in
catheterized patients with bacteriuria without UTI. (See 'Clinical
features' above.)
●The diagnosis of a catheter-associated UTI is made by the finding of
bacteriuria in a catheterized patient who has signs and symptoms that are
consistent with UTI or systemic infection and are otherwise unexplained.
Consistent findings may be specific to the urinary tract or may be more
general, such as fever, leukocytosis, or signs of sepsis. If the diagnosis is
based on such nonspecific findings, the evaluation should rule out the
possibility of other systemic infections (eg, bacteremia, pneumonia, skin or
soft tissue infection) prior to attributing them to a catheter-associated UTI.
(See 'Diagnosis' above.)
●For older patients with an indwelling urinary catheter and a change in
functional or mental status, we do not check urine studies or otherwise make
the diagnosis of UTI in the absence of focal urinary tract symptoms or
systemic signs of infection. (See 'General approach' above and "Approach to
infection in the older adult", section on 'Urinary tract infection'.)
●Ideally, urine samples for culture should be obtained by removing the
indwelling catheter and obtaining a midstream specimen or, if ongoing
catheterization is warranted, a specimen through a new catheter. When this is
not possible, the culture should be obtained through the catheter port, not the
drainage bag. (See 'Specimen collection' above.)
●Antimicrobial selection should be based upon the culture results when
available. However, in some cases, prompt treatment is warranted prior to the
availability of culture data. In such cases, empiric antimicrobial choice should
be tailored to results of past cultures, use of prior antimicrobial therapy,
community prevalence of antimicrobial resistance, and antimicrobial allergies
of the patient. Urine Gram stain, if available, can also guide empiric
antimicrobial choice. Depending on the clinical response, the infecting
organism, and the agent used for treatment, 7 to 14 days of therapy is
generally appropriate. (See 'Antimicrobial therapy' above.)
 ●Ingeneral, patients with infection who no longer require catheterization
should have the catheter removed and receive appropriate antimicrobial
therapy. Patients who require extended catheterization should be managed
with intermittent catheterization, if possible. If long term catheterization is
needed and intermittent catheterization is not feasible, the catheter should be
replaced at the initiation of antimicrobial therapy. (See 'Catheter
management' above.)
●Evaluating for asymptomatic bacteriuria in patients with indwelling catheters
is warranted only in the setting of pregnancy or prior to urologic procedures
for which mucosal bleeding is anticipated. For other asymptomatic patients
with indwelling catheters, routine urine cultures and urinalyses are not
warranted and treatment of incidentally discovered asymptomatic bacteriuria
is not indicated. (See 'Asymptomatic bacteriuria' above.)
●Avoidance of unnecessary catheterization, use of sterile technique for
insertion, and removal as soon as possible are essential to the prevention of
catheter-associated UTI. Antimicrobial agents have no role in prevention of
infection for the majority of patients with urinary catheters.
(See 'Prevention' above and "Placement and management of urinary bladder
catheters in adults".)
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Topic 8054 Version 23.0

GRAPHICS
Foley catheter system
Ideally urine samples for culture should be obtained by removing the indwelling catheter and obtaining

a midstream specimen. If ongoing catheterization is needed, ideally the catheter should be replaced

prior to collecting a urine sample for culture, to avoid culturing bacteria present in the biofilm of the

catheter but not in the bladder. Many systems have a "needleless" site that can be cleansed prior to

specimen collection. If a sample is being collected without catheter removal, urine should be obtained

from the port in the drainage system. For circumstances in which the above approaches are not

possible, the culture should be obtained by separating the catheter from the drainage system.

Although this approach is associated with some risk of introducing microbes into the closed system,

culture results from urine collected from the drainage bag cannot be used to guide treatment.
Graphic 70120 Version 1.