How is UTI diagnosed in residents with chronic indwelling catheters?
Residents with chronic catheters uniformly have bacteriuria and pyuria. Urinalysis abnormalities, such as pyuria and smelly or cloudy urine, are not sufficient for diagnosis of symptomatic urinary infection in a resident with an indwelling catheter. For the elderly resident with an indwelling urethral catheter, fever, by itself, may be a presentation of symptomatic urinary infection if there are no apparent alternate sources. Localizing symptoms, such as obstruction, hematuria, or suprapubic or costovertebral pain or tenderness, are present in only a minority of patients. If symptomatic urinary infection is suspected, the indwelling catheter should be replaced and a urine specimen for culture should be obtained through the new catheter before initiating antimicrobial therapy.
