This patient likely has a catheter-associated urinary tract infection (CAUTI), and his catheter should be removed and treatment provided for the infection. Fever with no other identifiable cause, suprapubic tenderness, and a urine culture growing 103 or more colony-forming units in a patient with an indwelling urinary catheter are compatible with the diagnosis of CAUTI. Other signs and symptoms that may suggest CAUTI include acute hematuria, costovertebral angle tenderness, pelvic discomfort, malaise, rigors, or confusion. It is not possible to assess for dysuria or urgency while the catheter is in place, but these symptoms may be present if the catheter is removed. Age older than 50 years and diabetes mellitus are two risk factors for CAUTI, as is prolonged catheterization. Catheters inserted in the operating room should be removed within 2 days after surgery to prevent CAUTI, unless the patient has undergone urologic surgery or other surgery on contiguous structures of the genitourinary tract, in which case it may be acceptable to keep the catheter in place longer. Treatment of CAUTI includes removing the urinary catheter if possible because bacteria may be embedded in biofilm and may not be reached by antimicrobial agents. Catheters in place for more than 2 weeks should be removed or changed before a urinalysis and culture are performed; otherwise, inaccurate results may be obtained, representing organisms present in biofilm and not necessarily causing UTI.
Although antimicrobial stewardship includes narrowing antibiotic coverage to a specific organism involved, awaiting sensitivity results to guide antimicrobial selection would not be appropriate in this patient with evidence of CAUTI. Empiric antimicrobial coverage based on likely infecting organisms and local resistance patterns with subsequent focused therapy when sensitivities are determined would be indicated in this patient.
The patient's symptoms and urine culture indicate he has a CAUTI; therefore, repeating a urinalysis and culture in 24 hours without treatment would not be appropriate.
No treatment is necessary for patients with asymptomatic bacteriuria, defined as bacteriuria of 103 colony-forming units or greater without signs or symptoms of UTI. However, this patient has evidence of active infection, so treatment is indicated.