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Symptomatic catheter-associated urinary tract infection — MSRA MCQ

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HardUrologySymptomatic catheter-associated urinary tract infectionMSRA

An 81-year-old man with Parkinson’s disease has a long-term urethral catheter for chronic urinary retention. His catheter was last changed 12 days ago and remains patent. He develops new suprapubic discomfort, temperature 38.1°C and malaise over 24 hours. He has no loin pain, rigors or vomiting; blood pressure is 128/74 mmHg and heart rate is 88/min. There is no alternative source of infection on assessment. Urine is cloudy, and a dipstick performed by the care home is positive for nitrites and leucocytes. He can take oral medication and his eGFR is 64 mL/min/1.73 m². Which is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Obtain an aseptic urine sample from the catheter sampling port, start empirical oral antibiotics after sampling, and arrange catheter change as soon as possible.

Explanation lettering: D = shown as C · C = shown as D

This is a symptomatic catheter-associated UTI: the new suprapubic discomfort, fever and malaise provide compatible clinical features, with no alternative infective focus. Cloudy urine and a positive dipstick do not establish the diagnosis in a catheterised person, but neither do they negate the clinically significant symptoms. A urine specimen should be taken aseptically from the sampling port before antibiotics, then sent for culture and susceptibility testing. As he is clinically stable, has no upper-tract features and can take oral treatment, empirical oral antibiotics can be started without awaiting culture. Because the catheter has been in place for more than 7 days and remains required, it should be changed promptly; this must not delay antibiotic treatment. B misses the recommendation to remove or change a catheter that has been in place for more than 7 days in catheter-associated UTI. C uses an unsuitable specimen source: if the catheter is changed, the sample should be taken from the new catheter, and replacement must not delay treatment. D uses a drainage-bag specimen, which is not appropriate for culture. E would be appropriate for asymptomatic bacteriuria, not for this symptomatic presentation.

Reference: NICE NG113: Urinary tract infection (catheter-associated): antimicrobial prescribing — Recommendations (2018) — https://www.nice.org.uk/guidance/ng113/chapter/Recommendations NICE NG113: Urinary tract infection (catheter-associated): antimicrobial prescribing — Recommendations (2018) — https://www.nice.org.uk/guidance/ng113/chapter/Recommendations NICE QS90: Urinary tract infections in adults — Quality statements (2023) — https://www.nice.org.uk/guidance/qs90/chapter/Quality-statements