GPAtlas🧭 When to suspect
A catheter-associated urinary tract infection (CAUTI) is a symptomatic infection of the bladder or kidneys in a person with an indwelling or intermittent urinary catheter. The defining difficulty in primary care is that bacteriuria is almost universal in catheterised patients – after a catheter has been in place for around a month, nearly everyone has bacteria in the urine. A positive culture therefore confirms colonisation, not infection, and on its own is never a reason to prescribe.
Because of this, CAUTI is a clinical diagnosis. Suspect it when a catheterised patient develops new or worsening systemic features – fever, rigors, malaise or new delirium – or new loin, flank or suprapubic pain, rather than the classic lower urinary tract symptoms (dysuria, frequency) which are usually absent or masked by the catheter. Crucially, do not use a urine dipstick: catheters colonise quickly and give a positive result regardless of infection.
| Points towards CAUTI (consider treating) | Points towards colonisation (do not treat) |
|---|---|
• New fever, rigors or systemic malaise |
• Positive culture with no new symptoms |
• New-onset delirium or acute functional decline (after excluding other sources) |
• Cloudy or strong-smelling urine in isolation |
• New suprapubic, loin or flank pain |
• Long-standing, stable bacteriuria |
• New visible haematuria with systemic upset |
• Asymptomatic patient, any catheter duration |
Source: NICE NG113 · NICE QS90
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