This handout is for catheter-associated uti (cauti) — indwelling / suprapubic / intermittent / long-term. Your care team identified this based on: patient with indwelling catheter develops fever, suprapubic pain, cva tenderness, dysuria after removal, or new altered mental status (idsa 2009/2019 cauti).
Other reasons your team may use this plan: positive culture ≥10^3 cfu/ml in catheterised patient — asymptomatic bacteriuria is the default; treat only if symptomatic (idsa 2019); long-dwell catheter (>30 d) — polymicrobial / biofilm-resistant pattern (idsa 2019); suprapubic catheter + new urinary or systemic symptoms (idsa 2019).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| Remove indwelling catheter when feasible (HOUDINI: Haematuria, Obstruction, Urinary retention, Decubitus ulcer healing, Input/output strict monitoring required, Not for incontinence alone, Immobility severe, end-of-life) | — | — | — | IDSA 2019 — primary intervention; biofilm cannot be cleared with abx alone (PMID 20175247) |
| Replace catheter BEFORE culture and treatment (if retained) | — | — | — | IDSA 2019 — minimises biofilm bias in culture and exposes new mucosa to abx; replacement is bundled with treatment initiation |
| Convert to intermittent self-cath when feasible | — | — | — | IDSA 2019 / AUA 2022 — fewer biofilm episodes than indwelling; education + supplies |
Plan: CAUTI — source control (remove / replace catheter) + empiric ceftriaxone / cefepime / pip-tazo / ertapenem (per risk) + candiduria fluconazole + ASB DO-NOT-TREAT doctrine
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Catheter-care bundle (HOUDINI prompt every shift); urology referral if recurrent CAUTI / chronic catheterisation; intermittent self-cath education if applicable; do NOT screen / treat ASB unless pregnancy or pre-procedure (IDSA 2019; USPSTF 2019)
Guideline: IDSA 2010 Hooton CAUTI guideline + IDSA Asymptomatic Bacteriuria 2019 (Nicolle) + IDSA 2020 MDR-GNB (Tamma — ESBL/CRE/DTR) + IDSA acute uncomplicated cystitis/pyelonephritis 2011 (Gupta) + IDSA Candidiasis 2016 (Pappas — candiduria)