Answer: Catheter-Associated Infection in a Resident of a Long-Term Care Facility

Correct answer: C

Complicated UTIs can be caused by metabolic, functional, or anatomical abnormalities and can involve both the upper and lower tracts.1 Upon admission to long-term care facilities, 13% of men and 12% of women have an indwelling urinary catheter.2 UTIs are the most common infection, making up 3.0% to 5.2% of reported infections in long-term care facilities.3 Greater than 50% of bacteremia cases in long-term care facilities are caused by catheter-associated infections.4 Accounting for 24% of cases, Escherichia coli is the most common organism associated with catheter-associated UTIs, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species.5

Initial treatment should include broad-spectrum antibiotics such as penicillins or β-lactams, cephalosporins, or fluoroquinolones.6 In all cases of complicated UTIs, a culture should be obtained. Based on the culture results, a more focused antibiotic regimen may be warranted.6 Treatment response should be seen within 24 to 48 hours. Prophylactic antibiotics should be avoided in patients with long-term indwelling catheters.6


1. Brusch JL. Pathophysiology of complicated urinary tract infection (UTI). Medscape. Updated July 24, 2017. Accessed April 18, 2021.

2. Rogers MA, Mody L, Kaufman SR, Fries BE, McMahon LF Jr, Saint S. Use of urinary collection devices in skilled nursing facilities in five states. J Am Geriatr Soc. 2008;56(5):854-861.

3. Dwyer LL, Harris-Kojetin LD, Valverde RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc. 2013;61(3):342-349.

4. Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3:23.

5. Guidelines for prevention of catheter associated urinary tract infections. Catheter-associated urinary tract infections. Infection Control. Centers for Disease Control and Prevention. Reviewed November 5, 2015. Accessed April 18, 2021.

6. Sabih A, Leslie SW. Complicated urinary tract infections. In: StatPearls [Internet]. StatPearls Publishing; January 2021.