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can lead to encrustation and obstruction of the catheter . Treating ASB is not recommended because it does not
34
Individuals with catheters most commonly harbor E. coli, En- reduce the frequency of UTIs and can lead to reinfections
terococcus faecalis, and Proteus mirabilis. Additionally, urea- with resistant bacteria . The optimal choice of therapy does
37
se-producing bacteria such as Proteus mirabilis, Morganella not differ from patients without catheters (Table 1). Tre-
morganii, Klebsiella pneumoniae, and Providencia stuartii are atment should last for seven days if there is a rapid respon-
frequently encountered . Proteus mirabilis is particularly se to therapy. Prolonged treatment leads to more frequent
34
active in biofilm and crystalline biofilm formation and is adverse effects. The benefit of removing the catheter before
responsible for approximately 80% of all catheter obstructi- starting therapy is reflected in reduced relapses and a re-
ons . duction in the number of bacteria remaining in the biofilm.
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The clinical presentation of symptomatic infection in Prevention of infections associated with indwelling cat-
individuals with catheters most commonly involves high heters is included in existing recommendations 38, 39 . The
fever without local genitourinary symptoms . In some pa- most important thing is to reduce the use of catheters or
23
tients, pain and tenderness in the costovertebral area, cat- use them for as short a time as possible. Some authors
heter obstruction, or hematuria may occur. The consensus also recommend external, condom catheters, which carry
regarding initiating empirical antibiotic therapy implies the a lower risk of infection . Special attention should be paid
40
presence of one of the following symptoms: high fever, new to non-traumatic catheter placement to prevent bleeding,
costovertebral angle tenderness, new-onset delirium, or the which predisposes to infection. It is important to promptly
absence of an alternative source of infection . recognize obstruction and replace the catheter. Special cat-
36
heters impregnated with antimicrobial agents or drainage
It is advisable to take a sample with a new catheter when bags with antiseptics do not seem to have met expectations
the finding is exclusively from urine, not from the biofilm, in terms of reducing infection rates . During catheter re-
41
and a count higher than 10 CFU/mL is considered relevant placement, transient bacteremia may occur, which does not
for defining bacteriuria. Additionally, it is recommended to have serious consequences, so antimicrobial prophylaxis is
initiate therapy only after replacing the catheter if it has not recommended during catheter replacement.
been in place for more than two weeks .
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Conclusion

In elderly individuals, there is a high prevalence of asymptomatic bacteriuria and urinary tract
infections. Asymptomatic bacteriuria does not require treatment except before urological surgical
procedures. The diagnosis of symptomatic infections is often overdiagnosed, leading to antibiotic
overuse and reinfection with resistant microorganisms.

In individuals residing in care facilities, distinguishing between asymptomatic bacteriuria (ASB)

and urinary tract infection (UTI) is not easy due to the unreliability and nonspecificity of symptoms.
Individuals with indwelling urinary catheters are at increased risk for UTIs, and special diagnostic,
therapeutic, and preventive strategies are applied for them.

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52 DOI: 10.5937/Galmed2409055D