Urinary catheterization

Case report:

A 76 year-old patient has been wearing 12 weeks a transurethral indwelling catheter for urinary retention in a prostatic hypertrophy; an operation is not possible due to severe underlying diseases and in view of a recent past heart attack at the time. The patient complains of pain in the bladder region, fever and in recent days also has right-sided flank pain. Furthermore, there are fatigue, lack of appetite and urine has become increasingly murky in recent days.

Diagnosis:

On physical examination, a clear knock and pressure pain in the right renal bearing is determined. The circuit conditions are unremarkable except for a tachycardia at 105 / min; the increased body temperature at 38.2 � C axillary is confirmed. Sonography of the kidney does not make reference to a jammed renal pelvis.
Microscopic examination of the urine shows a clear leucocyturia and bacteriuria. In catheter urine can Klebsiella pneumoniae (107 / ml) are detected with resistance to cotrimoxazole (EUSAPRIM others), doxycycline (VIBRAMYCIN others) and amoxicillin (Amoxypen others).

Pathogenesis:

In a transurethral urinary catheter is a high risk for an ascending urinary tract infection - about 50% of patients with such a catheter bakteriurisch within two weeks. Pathogens can be either reached during insert the catheter into the bladder, can along the outer surface of the catheter ascendant reach the bladder or it may lead to contamination of the drainage system - especially when disconnections between the catheter and collection bag - come.

Therapy:

The asymptomatic bacteriuria is not treated with antibiotics. However, appear clear symptoms of infection, and there is a clear leucocyturia, should be dealt with selectively on the basis of resistance testing over seven up to 14 days with antibiotics. In the here described patient treatment with 500 mg twice cefuroximaxetil (ELOBACT etc.) is introduced. Alternative products would fluoroquinolones like ofloxacin (Tarivid others) or ciprofloxacin (Cipro, etc.) or aminobenzyl penicillins with beta-lactamase inhibitors such as ampicillin plus sulbactam (UNACID) or amoxicillin plus clavulanic acid (Augmentin). It is also recommended to change the urinary catheter after initiation of therapy and in the medium to create a suprapubic catheter.