On when guidelines conflict: Patient safety, quality of life and CAUTI reduction in patients with spinal cord injury

The editorial discusses a hypothetical case of Mr. Jones, a tetraplegic patient with an indwelling catheter, who is diagnosed with a CAUTI based on NHSN guidelines due to fever and a positive urine culture, despite lacking urinary symptoms. Treating asymptomatic bacteriuria in such cases can lead to antibiotic resistance and complications, without necessarily clearing the infection due to the indwelling catheter. The author suggests that the CDC should revise CAUTI guideline definitions to account for special circumstances, like patients with suprapubic catheters or incontinent ileovesicostomies, who may have symptomatic UTIs that are not counted as CAUTIs.

• 1
  The NHSN guideline definition for CAUTI can lead to misdiagnosis in patients with spinal cord injury who have asymptomatic bacteriuria but meet the criteria of fever and a positive urine culture.
• 2
  Treating asymptomatic bacteriuria in patients with indwelling catheters can lead to antibiotic resistance and other complications without necessarily resolving the infection.
• 3
  Current CAUTI definitions do not adequately account for patients with alternative catheter management strategies (e.g., suprapubic catheters) who may experience symptomatic UTIs.