Answer: Catheter-Associated Infection in a Resident of a Long-Term Care Facility

Correct answer: C

Complicated UTIs can be caused by metabolic, functional, or anatomical abnormalities and can involve both the upper and lower tracts.1 Upon admission to long-term care facilities, 13% of men and 12% of women have an indwelling urinary catheter.2 UTIs are the most common infection, making up 3.0% to 5.2% of reported infections in long-term care facilities.3 Greater than 50% of bacteremia cases in long-term care facilities are caused by catheter-associated infections.4 Accounting for 24% of cases, Escherichia coli is the most common organism associated with catheter-associated UTIs, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species.5

Initial treatment should include broad-spectrum antibiotics such as penicillins or β-lactams, cephalosporins, or fluoroquinolones.6 In all cases of complicated UTIs, a culture should be obtained. Based on the culture results, a more focused antibiotic regimen may be warranted.6 Treatment response should be seen within 24 to 48 hours. Prophylactic antibiotics should be avoided in patients with long-term indwelling catheters.6

References

1. Brusch JL. Pathophysiology of complicated urinary tract infection (UTI). Medscape. Updated July 24, 2017. Accessed April 18, 2021. https://emedicine.medscape.com/article/2039975-overview

2. Rogers MA, Mody L, Kaufman SR, Fries BE, McMahon LF Jr, Saint S. Use of urinary collection devices in skilled nursing facilities in five states. J Am Geriatr Soc. 2008;56(5):854-861. https://doi.org/10.1111/j.1532-5415.2008.01675.x

3. Dwyer LL, Harris-Kojetin LD, Valverde RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc. 2013;61(3):342-349. https://doi.org/10.1111/jgs.12153

4. Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3:23. https://doi.org/10.1186/2047-2994-3-23

5. Guidelines for prevention of catheter associated urinary tract infections. Catheter-associated urinary tract infections. Infection Control. Centers for Disease Control and Prevention. Reviewed November 5, 2015. Accessed April 18, 2021. https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html

6. Sabih A, Leslie SW. Complicated urinary tract infections. In: StatPearls [Internet]. StatPearls Publishing; January 2021. https://www.ncbi.nlm.nih.gov/books/NBK436013/