Bacteria, Epidemiology, Infectious Diseases, rare infectious disease

Catheter-associated UTI (CAUTIs) | Common HAIs

Author Chandana Balasubramanian , 09-May-2024

Urinary tract infections (UTIs), especially those linked to the use of catheters—known as catheter-associated urinary tract infections (CAUTIs)—are the most common type of infection picked up in hospitals. In fact, they account for half of all hospital-acquired infections (HAIs) and more than 30% of infections in acute care settings [1,2].


The impact of CAUTIs is extensive, significantly contributing to increased patient morbidity and mortality, prolonged hospital stays, and costing the healthcare system billions of dollars. However, with the right interventions, 69% of CAUTIs can be prevented [3,4].


This highlights the critical need for stringent catheter management and proactive infection control measures within healthcare settings. 


As we dive deeper, we’ll explore the significant challenges and necessary interventions for managing UTIs as healthcare-associated infections.


Health consequences of CAUTIs

CAUTIs can cause serious health issues, including heart conditions like endocarditis and sepsis [4]. 

Endocarditis is an inflammation of the heart’s inner lining. Sepsis, on the other hand, is an infection that escalates rapidly, triggering widespread inflammation and an intense immune response throughout the body to fight it.

Estimates show that over 13,000 deaths a year are associated with healthcare-associated UTIs (CAUTIs) [5].


Disease-causing agents

Escherichia coli is the most common infection-causing bacteria for CAUTIs. Other agents include Staphylococcus, Pseudomonas aeruginosa, Enterobacteriaceae, and Candida [6].


Risk Factors
  • Longer-term catheter use: Prolonged urinary catheter use is one of the biggest risk factors for developing CAUTIs. The longer a catheter is in place, the higher the chance that bacteria will colonize it, leading to an infection.
  • Sex: Females are more susceptible to HAI UTIs than males.
  • Catheter insertion issues: Improper insertion and removal techniques can also significantly increase the risk. If catheters are not inserted or removed correctly, bacteria can enter the urinary tract.
  • Regular catheter maintenance: insufficient periodic catheter care plays a critical role. Regular and meticulous maintenance of the catheter is essential to prevent bacterial growth and subsequent infection [1].


  • Cloudy urine: An unusual turbidity can indicate an infection.
  • Blood in the urine: This symptom often signals irritation or infection in the urinary tract.
  • Strong urine odor: A noticeable change in the smell of urine is a common indicator.
  • Urine leakage around the catheter: This might suggest the catheter is blocked or improperly positioned.
  • Pressure, pain, or discomfort in the lower back or stomach: These are typical symptoms associated with urinary infections.
  • Chills, shivering, shaking (rigors): Severe body responses that often accompany infections.
  • Fever or very low temperature (below 36°C): Both are systemic signs of infection.
  • Unexplained fatigue, vomiting, and delirium: General symptoms that can worsen with the severity of the infection [7].



Diagnosis of CAUTIs is primarily based on combining clinical symptoms with bedside urinalysis. 

Key indicators to look for include:

  • Presence of leukocytes (white blood cells): Their presence often signifies an ongoing immune response to infection.
  • Nitrites in urine: These are produced by certain types of bacteria, indicating an infection.
  • Lab tests: Microscopy, culture, and sensitivity tests help identify the specific bacteria causing the infection and determine the most effective antibiotics for treatment, ensuring a targeted approach to managing the infection [8].



Treating catheter-associated urinary tract infections effectively involves a few key strategies:

  • Targeted antibiotic use: Only patients who show symptoms of CAUTI are treated with antibiotics to avoid unnecessary medication use and resistance.
  • Change of catheter: It’s crucial to replace the catheter before starting antibiotic treatment to prevent re-infection from a contaminated catheter.
  • Antibiotic selection based on culture: Antibiotics should be chosen based on urine culture sensitivities to ensure they are effective against the specific bacteria causing the infection.
  • Duration of antibiotic treatment: Typically, a 7-day course of antibiotics is sufficient for prompt resolution of symptoms. However, in more severe cases, the treatment may be extended to a 10-day course to ensure complete eradication of the infection [7,8].



Effective prevention of hospital-acquired infections (HAIs) like catheter-associated urinary tract infections focuses on meticulous catheter management:

  • Judicious and limited use of urinary catheters: To minimize infection risk, catheters should only be used when absolutely necessary and removed as soon as possible.
  • Aseptic/clean insertion and removal techniques: Ensuring that catheters are inserted and removed using sterile techniques to prevent introducing bacteria into the urinary tract.
  • Daily catheter care: Maintain a closed drainage system: This helps prevent bacteria from entering the system.
  • Ensure the catheter and collecting tube are free from kinking: This prevents urine backflow, which can lead to infections.
  • Keep the collecting bag below the level of the bladder: This helps avoid urine return to the bladder, reducing infection risk.
  • Empty the collecting bag regularly: Regular emptying helps maintain the hygiene and functionality of the catheter system [8, 9].



Catheter-associated urinary tract infections (CAUTIs) are a major challenge in healthcare settings, significantly affecting patient health and increasing hospital costs. 

Understanding the risks, symptoms, and effective management strategies for CAUTIs is crucial. Whether it’s employing rigorous infection control measures, opting for judicious catheter use, or applying precise treatment protocols, every step counts toward reducing the incidence of these infections. 

Armed with this knowledge, healthcare providers can greatly enhance patient outcomes and minimize the negative impacts of CAUTIs in hospital environments. Let’s commit to vigilance and proactive care to safeguard against these prevalent infections.


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[1]H. Rubi, G. Mudey, and R. Kunjalwar, “Catheter-associated urinary tract infection (CAUTI),” Cureus, vol. 14, no. 10, 2022.
[2]“Background,”, 28-Mar-2019. [Online]. Available: [Accessed: 09-May-2024].
[3]C. S. Hollenbeak and A. L. Schilling, “The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review,” Am. J. Infect. Control, vol. 46, no. 7, pp. 751–757, 2018.
[4]A. S. Letica-Kriegel et al., “Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals,” BMJ Open, vol. 9, no. 2, p. e022137, 2019.
[5]R. M. Klevens et al., “Estimating health care-associated infections and deaths in U.s. hospitals, 2002,” Public Health Rep., vol. 122, no. 2, pp. 160–166, 2007.
[6]D. Peng et al., “Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis,” Am. J. Infect. Control, vol. 46, no. 12, pp. e81–e90, 2018.
[7]“Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) Events,”, Jan-2024. [Online]. Available: [Accessed: 09-May-2024].
[8]C. E. Chenoweth, C. V. Gould, and S. Saint, “Diagnosis, management, and prevention of catheter-associated urinary tract infections,” Infect. Dis. Clin. North Am., vol. 28, no. 1, pp. 105–119, 2014.
[9]L. Atkins et al., “Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions,” Implement. Sci., vol. 15, no. 1, 2020.
Chandana Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network, and has a Masters degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

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