Having a catheter inserted can be a common medical procedure for some people, but it does come with the risk of developing an infection. Catheter-associated urinary tract infections (CAUTIs) are the most common type of hospital-acquired infection, so it’s important to monitor for signs of infection if you have a catheter.
What is a catheter?
A catheter is a thin, flexible tube that is inserted into the bladder to drain urine. There are two main types of catheters:
- Indwelling catheters – Also called Foley catheters, these are left in place for a period of time. They have a balloon at the tip that inflates to hold the catheter in place in the bladder.
- Intermittent catheters – Also called straight catheters, these are inserted temporarily to drain the bladder and then removed. People who are unable to urinate on their own often use intermittent catheters to empty the bladder.
People may need catheters for various medical reasons, such as difficulty urinating, incontinence, surgery, or during prolonged bedrest. The catheter drains urine from the bladder into a drainage bag.
Why can catheters cause infections?
There are a few reasons why catheter use increases the risk of getting an infection:
- The catheter provides a direct route for bacteria to enter the urinary tract.
- The catheter irritates the urethra and bladder, making it easier for bacteria to adhere and cause infection.
- Urine drainage bags attached to the catheter can allow bacteria to grow.
- The catheter can lead to the formation of urinary stones, which harbor bacteria.
- Long-term catheter use prevents the normal flushing of bacteria from the bladder during urination.
For these reasons, the longer a catheter remains in place, the higher the risk of developing a catheter-associated UTI. Infections can involve the urethra, bladder, kidneys, and even the bloodstream.
What are the symptoms of a catheter infection?
Some of the common signs and symptoms of a UTI related to a catheter include:
- Burning or pain when urinating
- Urinary frequency or urgency
- Cloudy, bloody, or foul-smelling urine
- Pelvic pain or discomfort
- Unexplained fever
- Confusion (in elderly patients)
However, symptoms aren’t always obvious, especially in the elderly or those with spinal cord injuries. Often the only sign is a change in the color or smell of the urine.
Who is at risk of catheter infections?
Anyone with a catheter is at higher risk. Some factors that increase the risk even further include:
- Female gender
- Older age
- Impaired immunity
- Diabetes
- Kidney problems
- Malnutrition
- History of prior catheter infections
- Prolonged catheter use
Tips to prevent catheter infections
Some tips that can help prevent CAUTIs include:
- Practice good hygiene – wash hands before handling catheter
- Insert catheter only when necessary and remove as soon as possible
- Make sure catheter is secured to prevent movement and urethral irritation
- Keep drainage bag below level of bladder and empty bag regularly
- Clean catheter insertion site daily with soap and water
- Avoid disconnecting catheter from drainage system unless necessary
- Stay hydrated to produce dilute urine
How are catheter infections diagnosed?
If a UTI is suspected, the doctor will likely ask about symptoms and perform a urinalysis looking for signs of infection, such as:
- Nitrites – produced by bacteria
- Leukocyte esterase – an enzyme released by white blood cells fighting infection
- White blood cells in urine
- Bacteria or yeast in urine culture
A urine culture is the main way to diagnose a UTI and identify the causative bacteria to determine the best antibiotic for treatment.
How are catheter infections treated?
Treatment involves antibiotics to clear the infection. Some general approaches include:
- Oral antibiotics for 7-14 days, based on urine culture results
- Intravenous antibiotics if infection has spread to kidneys or bloodstream
- Antibiotic irrigation through the catheter
- Removing and replacing the catheter if it is the suspected source
- Increasing fluid intake to flush bacteria from the urinary tract
If fever, pain, or other concerning symptoms develop, prompt medical care is needed. Recurrent UTIs may require prolonged antibiotic use and increased catheter care.
Can catheter infections be life-threatening?
Catheter-associated UTIs can potentially spread to the kidneys or bloodstream, becoming very serious. Risk factors for this include:
- Impaired immunity
- Diabetes
- Older age
- Kidney problems
- Delay in diagnosis or treatment
Severe complications can include:
- Sepsis – blood infection
- Septic shock with dangerously low blood pressure
- Kidney damage or failure
Rarely, the infection can spread to the prostate, epididymis, or heart valves leading to severe illness. However, most CAUTIs can be successfully treated with prompt appropriate antibiotic therapy.
Conclusion
In summary, a catheter-associated UTI should be suspected if there are any symptoms of infection, especially burning with urination, pelvic discomfort, or changes in urine appearance. Certain populations like the elderly and those with chronic illnesses are at higher risk. Diagnosis is made by urine testing and culture. Most infections can be resolved with antibiotics and additional catheter care, but delays can allow the infection to spread. With prompt treatment, serious complications are unlikely but still possible. Prevention with proper catheter use and hygiene is key.