9. URINALYSIS
Urinalysis should not be routinely performed on all long-term catheterised patients, as nearly all patients will have bacteria present in their urine. [201] Unjustified ordering or improper collection of urine for urinalysis or culture from catheterised patients often leads to adverse health care events, including over-treatment of patients with antimicrobial agents and thus predisposing to the development of multidrug-resistant organisms. [202]
Indications
Urinalysis/catheter specimen of urine should be undertaken when:
- Patients are systemically unwell
- Patients have a high temperature
- After lack of response to treatment
- Admitted/transferred to hospital to ascertain the presence of hospital- or community-acquired infection. [98]
Technique
A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CAUTI due to the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance. The urine culture should be obtained from the freshly placed catheter prior to initiation of antimicrobial therapy. [39]
Urine samples from a catheter must be obtained using aseptic technique from the needle-free sampling port by syringe aspiration. [24]
The sampling port has been specially designed to re-seal after aspiration of the urine sample. [203]
Obtain large volumes of urine for special analyses (not culture) aseptically from the drainage bag. [24] (LE: 1b)
If the indwelling catheter has been in place for > 14 days, the catheter should be changed, and the urine should be collected from the new catheter so that the sample is representative of the microorganisms really present in the bladder and not the microorganisms that have adhered to the interior wall of the catheter. [39]
For the procedure of Obtaining urine sample from an indwelling catheter, see Appendix P.
Dipstick
Bacterial colonisation during catheterisation is inevitable and does not require therapy in asymptomatic individuals; therefore, the use of a dipstick to detect UTI is not recommended. If a dipstick is used to detect glucose in the urine, it should be noted that uric acid and vitamin C can cause false-negative results. [204]
| Recommendations | LE | GR |
| For urinalysis, aspirate the urine from the needleless sampling port with a sterile syringe/cannula adapter after cleansing the port with a disinfectant [24] | 1b | B |
| Obtain large volumes of urine for special analyses (not culture) aseptically from the drainage bag [24] | 1b | B |
| Do not use the presence or absence of odorous or cloudy urine alone to differentiate catheter-associated asymptomatic bacteriuria from CAUTI. [14] | 3a | B |