Management of Urinary Retention and UTI in Patients with Long-Term Foley Catheters

Initial Assessment and Management

• The American College of Physicians and the Infectious Diseases Society of America recommend replacing the catheter before starting antimicrobial therapy if it has been in place for ≥2 weeks, as this improves clinical outcomes, decreases polymicrobial bacteriuria, shortens time to clinical improvement, and lowers rates of UTI recurrence 1
• Obtain a urine culture specimen after changing the catheter and allowing for urine accumulation while plugging the catheter, as recommended by the American Urological Association 3

Antimicrobial Treatment Duration

• The Infectious Diseases Society of America recommends treating patients with catheter-associated UTI (CAUTI) who have prompt resolution of symptoms for 7 days 4
• For patients with delayed response to treatment, the American College of Physicians recommends extending therapy to 10-14 days 4

Catheter Management During and After Treatment

• The American Urological Association recommends removing the catheter as soon as clinically appropriate to reduce the risk of recurrent infection 4, 2

Special Considerations

• The American Urological Association recommends urodynamic evaluation for patients with recurrent UTIs and an indwelling catheter to identify risk factors such as elevated post-void residual or vesicoureteral reflux 3
• The Infectious Diseases Society of America does not recommend using daily antibiotic prophylaxis in patients with long-term indwelling catheters, as this does not prevent UTI and increases bacterial resistance 3, 4

Common Pitfalls to Avoid

• The Infectious Diseases Society of America recommends against treating asymptomatic bacteriuria in catheterized patients, as it does not reduce subsequent CAUTI and increases antimicrobial resistance 5, 4