Strategies
Prophylactic Antimicrobials at Time of Catheter Removal or Replacement
ÎProphylactic antimicrobials, given systemically or by bladder irrigation, should
be administered routinely to patients at the time of catheter
placement to reduce CA-UTI (A-I) or at the time of catheter removal (B-I) or replacement (AIII) to reduce CA-bacteriuria.
> Comment: Data are insufficient to make a recommendation as to whether prophylactic antimicrobials in such patients reduce bacteremia.
Screening and Treatment of CA-ASB in Catheterized Patients to Reduce CA-UTI
ÎScreening and treatment of CA-ASB are ÎScreening and treatment of CA-ASB are ÎScreening and treatment of CA-ASB are recommended to reduce
subsequent CA-bacteriuria or CA-UTI in patients with short-term (A-II) or long-term (A-I) indwelling urethral catheters.
recommended to reduce
subsequent CA-bacteriuria or CA-UTI in patients with neurogenic bladders managed with intermittent catheterization (A-II).
recommended to reduce
subsequent CA-bacteriuria or CA-UTI in other catheterized patients (A-III), except in pregnant women (A-III) and patients undergoing urologic procedures for which visible mucosal bleeding is anticipated (A-III).
Screening and Treatment of CA-ASB at Catheter Removal to Reduce CA-UTI
ÎAntimicrobial treatment of CA-ASB that persists 48 hours after short-term indwelling catheter removal in women may be considered to reduce the risk of subsequent CA-UTI (C-I).
> Comment: Data are insufficient, however, to make a recommendation as to whether all women should be uniformly screened for CA-ASB at catheter removal.
> Comment: Data are insufficient to make a recommendation about screening or treatment of persistent CA-ASB in men.
Urine Culture and Catheter Replacement Before Treatment
ÎA urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI due to the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance (A-III).
ÎIf an indwelling catheter has been in place for more than 2 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced to hasten resolution of symptoms and to reduce the risk of subsequent CA-bacteriuria and CA-UTI (A-I).
> The urine culture should be obtained from the freshly placed catheter prior to the initiation of antimicrobial therapy to help guide treatment (A-II).
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