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Symptomatic catheter-associated lower urinary tract infection — MSRA MCQ

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ModerateUrinary Tract InfectionsSymptomatic catheter-associated lower urinary tract infectionMSRA

A 71-year-old woman has had an indwelling urethral catheter for 12 days following a failed trial without catheter for chronic urinary retention. She now reports 24 hours of new suprapubic pain and malaise. The catheter is draining freely. She has no fever, rigors, flank pain, vomiting or confusion, and observations are normal. She still requires continuous drainage pending urology review. Her eGFR is 62 mL/minute/1.73 m² and she has no drug allergies. A urine culture 4 months ago grew Escherichia coli resistant to trimethoprim and susceptible to nitrofurantoin. She has received no antibiotics in the past 3 months. What is the most appropriate immediate management?

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Correct answer: E — Replace the catheter, obtain an aseptic urine sample from the new catheter sampling port, and start nitrofurantoin 100 mg modified-release twice daily for 7 days

This is a symptomatic catheter-associated UTI (CAUTI): new suprapubic pain in a catheterised patient without an alternative source is sufficient to treat, despite the absence of fever or upper-tract features. As the catheter has been in place for more than 7 days and is still needed, it should be changed as soon as possible. When it is changed, the urine specimen should be obtained aseptically from the newly inserted catheter before antibiotics are taken. Immediate treatment should not be delayed while awaiting culture. Nitrofurantoin is an appropriate first-choice oral agent for CAUTI without upper-tract symptoms when eGFR is at least 45 mL/minute/1.73 m²; the recommended course is 7 days. Her previous isolate was trimethoprim-resistant, making trimethoprim inappropriate empirically. ([nice.org.uk](https://www.nice.org.uk/guidance/ng113/chapter/Recommendations?utm_source=openai)) B misses the recommended catheter change after more than 7 days. C inappropriately delays treatment of symptomatic infection. D uses a lower-UTI course length appropriate to uncomplicated infection in non-pregnant women, not CAUTI. E disregards relevant prior resistance data.

Reference: Urinary tract infection (catheter-associated): antimicrobial prescribing (NG113) — Recommendations (23 November 2018) — https://www.nice.org.uk/guidance/ng113/chapter/Recommendations Healthcare-associated infections: prevention and control in primary and community care (CG139) — Recommendations (March 2012) — https://www.nice.org.uk/guidance/cg139/chapter/recommendations