Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections

Table 1

Definitions for catheter-associated urinary tract infection.

2017/18 Guidelines on Neuro-Urology of the European Association of Urology (EAU) [4].; +Blok et al. EAU guidelines on Neuro-Urology 2015 [40]	Signs and/or symptoms accompanied by laboratory findings of a UTI (bacteriuria, leucocyturia^a, and positive urine culture).; Significant bacteriuria in persons performing IC is present with >10^2 colony-forming units (cfu)/mL, >10^4 cfu/mL in clean-void specimens, and any detectable concentration in suprapubic aspirates. The most common signs and symptoms in those with neuro-urological disorders are fever, new onset or increase in incontinence, including leaking around an indwelling catheter, increased spasticity, malaise, lethargy or sense of unease, cloudy urine with increased urine odour, discomfort or pain over the kidney or bladder, dysuria, or autonomic dysreflexia
2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America (IDSA) [41].	Symptoms or signs compatible with UTI with no other identified source of infection along with ≥10^3 cfu/mL of ≥1 bacterial species in a single catheter urine specimen or in a midstream voided urine specimen from a patient whose urethral, suprapubic, or condom catheter has been removed within the previous 48 h^b
ISCoS Urinary Tract Infection Basic Dataset [42].	(i) New onset of symptoms accompanied by laboratory findings (bacteriuria, leukocyturia and positive urine culture) of a UTI.; (ii) Symptoms: fever, urinary incontinence/failure of control or leaking around the catheter, spasticity, malaise, lethargy or sense of unease, cloudy urine, malodorous urine, pyuria/leukocyturia, back pain, bladder pain, dysuria, autonomic dysrreflexia (AD).; (iii) A clean-catch midstream technique from an immediately installed urine catheter. Any positive culture should be reported. The clinical Microbiological Laboratory (CML), 10^3 CFU ml^−1 is a reliable finding with standardized inoculation with 10 µl urine.

^aLeucocyturia is defined as 10 or more leucocytes in centrifuged urine samples per microscopic field (400×). ^bIn the catheterised patient, pyuria is not diagnostic of CA-bacteriuria or CAUTI, and the presence, absence, or degree of pyuria alone does not, by itself, differentiate catheter-associated asymptomatic bacteriuria from CAUTI. However, the absence of pyuria in a symptomatic catheterised patient suggests a diagnosis other than CAUTI.