Definitions and Diagnosis
ÎCA-ASB in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of ≥ 105
cfu/mL
of ≥ 1 bacterial species in a single catheter urine specimen in a patient without symptoms compatible with UTI (A-III).
ÎCA-ASB in a man with a condom catheter is defined by the presence of ≥ 105
cfu/mL of ≥ 1 bacterial species in a single urine specimen from a
freshly applied condom catheter in a patient without symptoms compatible with UTI (A-II).
ÎCA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source along with ≥ 103
cfu/mL of ≥ 1 bacterial species in a single catheter urine specimen
or in a midstream voided urine specimen from a patient whose urethral, suprapubic or condom catheter has been removed within the past 48 hours (A-III).
> Data are insufficient to recommend a specific quantitative count for defining CA-UTI in symptomatic men when specimens are collected by condom catheter.
ÎSigns and symptoms compatible with CA-UTI include new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute hematuria, pelvic discomfort and, in those whose catheters have been removed, dysuria, urgency, frequency or suprapubic pain or tenderness (A-III).
> In patients with spinal cord injury, increased spasticity, autonomic dysreflexia or sense of unease are also compatible with CA-UTI (A-III).
ÎIn the catheterized patient, pyuria is NOT diagnostic of CA-bacteriuria or CA-UTI (AII).
> The presence, absence or degree of pyuria should not be used to differentiate CA-ASB from CA-UTI (A-II).
> Pyuria accompanying CA-ASB should NOT be interpreted as an indication for antimicrobial treatment (A-II).
> The absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI (A-III).
ÎIn the catheterized patient, the presence or absence of odorous or cloudy urine alone should NOT be used to differentiate CA-ASB from CA-UTI or as an indication for urine culture or antimicrobial therapy (A-III).
ÎScreening for CA-ASB should NOT be done except in research studies evaluating interventions designed to reduce CA-ASB or CA-UTI (A-III) and in selected clinical situations such as pregnant women (A-III).
ÎThe term "CA-bacteriuria" is used when no distinction is made between CA-ASB and CA-UTI, but is predominantly CA-ASB.
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