Catheter-associated UTIs are associated with increased mortality and costs. Risk factors for catheter-associated UTIs include the duration of catheterization, lack of systemic antibiotic therapy, female gender, age older than 50 years, and azotemia. To help prevent infection, urinary catheters should be avoided when possible and used only as long as needed. The catheter should be inserted with strict aseptic technique by trained persons, and a closed system should be used at all times. Treatment of catheter-associated UTI depends on the clinical circumstances. Symptomatic patients (e.g., those with fever, chills, dyspnea, and hypotension) require immediate antibiotic therapy along with removal and replacement of the urinary catheter if it has been in place for a week or longer. In an asymptomatic patient, therapy should be postponed until the catheter can be removed. Patients with long-term indwelling catheters seldom become symptomatic unless the catheter is obstructed or is eroding through the bladder mucosa. In patients who do become symptomatic, appropriate antibiotics should be administered and the catheter changed. Therapy for asymptomatic catheterized patients leads to the selection of increasingly antibiotic-resistant bacteria.
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