Catheter-Associated Urinary Tract Infection (CAUTI)

🔍 When to Suspect

New onset or worsening of systemic symptoms like fever, chills, malaise, or delirium in a catheterised patient, often without classic lower urinary tract symptoms

From the full topic in The Ocean Library: Catheter-Associated Urinary Tract Infection (CAUTI)

🧭 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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