• Catheter-associated UTIs. In: Grabe M, Bishop MC, Bjerklund-Johansen TE, Botto H, Çek M, Lobel B, Naber KG, Palou J, Tenke P. Guidelines on the management of urinary and male genital tract infections. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. p. 70-1. [1 reference]

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

Grades of recommendation (A-C) are defined at the end of the "Major Recommendations" field.

General Aspects

1. Written catheter care protocols are necessary. (B)
2. Health care workers should observe protocols on hand hygiene and the need to use disposable gloves between catheterised patients. (A)

Catheter Insertion and Choice of Catheter

3. An indwelling catheter should be introduced under antiseptic conditions. (B)
4. Urethral trauma should be minimised by the use of adequate lubricant and the smallest possible catheter calibre. (B)
5. Antibiotic-impregnated catheters may decrease the frequency of asymptomatic bacteriuria within 1 week. There is, however, no evidence they decrease symptomatic infection. Therefore, they cannot be recommended routinely. (B)
6. Silver alloy catheters significantly reduce the incidence of asymptomatic bacteriuria, but only for less than 1 week. There was some evidence of reduced risk for symptomatic urinary tract infection (UTI). Therefore, they may be useful in some settings. (B)

Prevention

7. The catheter system should remain closed. (A)
8. The duration of catheterisation should be minimal. (A)
9. Topical antiseptics or antibiotics applied to the catheter, urethra or meatus are not recommended. (A)
10. Benefits from prophylactic antibiotics and antiseptic substances have never been established; therefore, they are not recommended. (A)
11. Removal of the indwelling catheter after non-urological operation before midnight may be beneficial. (B)
12. Long-term indwelling catheters should be changed in intervals adapted to the individual patient, but must be changed before blockage is likely to occur; however, there is no evidence for the exact intervals of changing catheters. (B)
13. Chronic antibiotic suppressive therapy is generally not recommended. (A)

Diagnostics

14. Routine urine culture in asymptomatic catheterised patients is not recommended. (B)
15. Urine, and in septic patients also blood for culture must be taken before any antimicrobial therapy is started. (C)
16. Febrile episodes are only found in less than 10% of catheterised patients living in a long-term facility. It is therefore extremely important to rule out other sources of fever. (A)

Treatment

17. Whilst the catheter is in place, systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended, except in certain circumstances: especially prior to traumatic urinary tract interventions. (A)
18. In case of asymptomatic candiduria, neither systemic nor local antifungal therapy is indicated, but removal of the catheter or stent should be considered. (A/C)
19. Antimicrobial treatment is recommended only for symptomatic infection. (B)
20. In case of symptomatic catheter associated UTI it may be reasonable to replace or remove the catheter before starting antimicrobial therapy if the indwelling catheter has been in place for more than 7 days. (B)
21. For empiric therapy broad-spectrum antibiotics should be given based on local susceptibility patterns. (C)
22. After culture results are available antibiotic therapy has to be adjusted according to sensitivities of the pathogens. (B)
23. In case of candiduria associated with urinary symptoms or if candiduria is the sign of a systemic infection, systemic therapy with antifungals are indicated. (B)
24. Elderly female patients may need treatment if bacteriuria does not resolve spontaneously after catheter removal. (C)

Alternative Drainage Systems

25. There is limited evidence that post-operative intermittent catheterisation reduces the risk of bacteriuria compared with indwelling catheter. No recommendation can be made. (C)
26. In appropriate patients suprapubic, condom drainage system or intermittent catheter are preferable to indwelling urethral catheter. (B)
27. There is little evidence suggesting that antibiotic prophylaxis decreases bacteriuria in patients using intermittent catheterisation; therefore, it is not recommended. (B)

Long-Term Follow Up

28. Patients with urethral catheters in place for 10 years or more should be screened for bladder cancer. (C)

Definitions:

Grades of Recommendation

1. Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial
2. Based on well-conducted clinical studies, but without randomized clinical studies
3. Made despite the absence of directly applicable clinical studies of good quality

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

• Catheter-associated UTIs. In: Grabe M, Bishop MC, Bjerklund-Johansen TE, Botto H, Çek M, Lobel B, Naber KG, Palou J, Tenke P. Guidelines on the management of urinary and male genital tract infections. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. p. 70-1. [1 reference]

Not applicable: The guideline was not adapted from another source.

2008 Mar

European Association of Urology - Medical Specialty Society

European Association of Urology

Management of Urinary and Male Genital Tract Infections Guidelines Writing Panel

Panel Members: M. Grabe (Chairman); M.C. Bishop; T.E. Bjerklund-Johansen; H. Botto; M. Çek; B. Lobel; K.G. Naber; J. Palou; P. Tenke

All members of the Management of Urinary and Male Genital Tract Infections guidelines writing panel have provided disclosure statements of all relationships which they have and which may be perceived as a potential source of conflict of interest. This information is kept on file in the European Association of Urology Central Office database. This guidelines document was developed with the financial support of the European Association of Urology (EAU). No external sources of funding and support have been involved. The EAU is a non-profit organisation and funding is limited to administrative assistance, travel, and meeting expenses. No honoraria or other reimbursements have been provided.

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

The following are available:

• EAU guidelines office template. Arnhem, The Netherlands: European Association of Urology (EAU); 2007. 4 p.
• The European Association of Urology (EAU) guidelines methodology: a critical evaluation. Arnhem, The Netherlands: European Association of Urology (EAU); 18 p.

The following is also available:

• Management of urinary and male genital tract infections. 2008, Ultra short pocket guidelines. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. 17 p.

Print copies: Available from the European Association of Urology, PO Box 30016, NL-6803, AA ARNHEM, The Netherlands.

None available

This NGC summary was completed by ECRI Institute on September 8, 2008. The information was verified by the guideline developer on December 8, 2008.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Downloads are restricted to one download and print per user, no commercial usage or dissemination by third parties is allowed.