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Diagnosis, Prevention, and Treatment of CatheterAssociated Urinary Tract Infection in Adults:
2009 International Clinical Practice Guidelines
from the Infectious Diseases Society of America
Thomas M. Hooton,1 Suzanne F. Bradley,3 Diana D. Cardenas,2 Richard Colgan,4 Suzanne E. Geerlings,7
James C. Rice,5,a Sanjay Saint,3 Anthony J. Schaeffer,6 Paul A. Tambayh,8 PeterTenke,9 and Lindsay E. Nicolle10,11

Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract
infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious
Diseases Society of America. The evidence-based guidelines encompass diagnostic criteria, strategies to reduce
the risk of CA-UTIs, strategies thathave not been found to reduce the incidence of urinary infections, and
management strategies for patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary
tract infection. These guidelines are intended for use by physicians in all medical specialties who perform
direct patient care, with an emphasis on the care of patients in hospitals and long-term care facilities.EXECUTIVE SUMMARY
Catheter-associated (CA) bacteriuria is the most common health care–associated infection worldwide and is
a result of the widespread use of urinary catheterization,
much of which is inappropriate, in hospitals and longterm care facilities (LTCFs). Considerable personnel
time and other costs are expended by health care institutions to reduce the rate of CA infections, especiallythose that occur in patients with symptoms or signs
referable to the urinary tract (CA urinary tract infection
[CA-UTI]). In these guidelines, we provide background

Received 23 November 2009; accepted 24 November 2009; electronically
published 4 February 2010.
Present affiliation: Department of Molecular and Experimental Medicine, The
Scripps Research Institute, La Jolla, California.Reprints or correspondence: Dr Thomas M. Hooton, 1120 NW 14th St, Ste
1144, Clinical Research Bldg, University of Miami Miller School of Medicine,
Miami, FL 33136 (
Clinical Infectious Diseases 2010; 50:625–663
2010 by the Infectious Diseases Society of America. All rights reserved.
DOI: 10.1086/650482

information on the epidemiologyand pathogenesis of
CA infections and evidence-based recommendations
for their diagnosis, prevention and management. Unfortunately, the catheter literature generally reports on
CA asymptomatic bacteriuria (CA-ASB) or CA bacteriuria (used when no distinction is made between CAASB and CA-UTI; such cases are predominantly CAASB), rather than on CA-UTI. As a result, most
recommendations in theseguidelines refer to CA-bacteriuria, because this is the only or predominant out-

These guidelines were developed by the Infectious Diseases Society of America
in collaboration with the American Geriatrics Society, American Society of
Nephrology, American Spinal Injury Association, American Urological Association,
Association of Medical Microbiology and Infectious Diseases–Canada, EuropeanAssociation of Urology , European Society of Clinical Microbiology and Infectious
Diseases, Society for Healthcare Epidemiology of America, Society of Hospital
Medicine, and the Western Pacific Society of Chemotherapy.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect toparticular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.

Urinary Catheter Guidelines • CID 2010:50 (1 March) • 625

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