Antibiotic prophylaxis for urinary catheter insertion
1. Scope of guidance
 This guidance applies to insertion, removal of change of urinary catheters.
 The guidance does not cover patient intermittent self-catheterisation.
2. Indications for prophylaxis
Antibiotic prophylaxis for urinary catheter insertion is not recommended as routine
practice, but should be given in the following situations:

Uncatheterised patients who require catheter insertion and are known to have
asymptomatic bacteriuria should be given prophylaxis according to the
sensitivities of the urinary isolate

Insertion for painless (chronic) urinary retention. Send CSU after catheterisation
and treat if confirmed UTI.

Removal post prostatic surgery

Catheter change/removal (long term catheter) IF risk factors are present. Assess
risk factors and give prophylaxis if present. The following risk factors are
receommended as indications for prophylaxis:
- A history of symptomatic urinary catheter-associated infection with previous
catheter changes or purulent urethral/suprapubic catheter exit site discharge
- Has catheter or meatal/suprapubic catheter exit site colonisation with
Staphylococcus aureus (MRSA)
- Recatheterisation within 14 days of initial catheterisation
- Blocked catheter (manipulation or change) or if traumatic catheterisation (give
prophylaxis as soon as possible and within 30 minutes)
- Catheter change in neutropenic patients
3. Situations where prophylaxis is NOT required
Prophylaxis prior to urinary catheter insertion / removal / change is NOT required for:

Catheter insertion/removal in patients with endocarditis risk factors

Catheter insertion/removal in patients with established prosthetic joints

Catheter insertion for painful (acute) urinary retention

Removal of catheter (unless post prostatic surgery or S.aureus colonised urine or
meatal sample)

Long term catheter insertion (unless urinary tract infection or known
asymptomatic bacteriuria at time of insertion)

Suprapubic catheter insertion (provided no UTI at time of insertion)

Change/removal of long term catheter (unless risk factors as above)
4. Patients with established urinary tract infection:

Patients with urinary tract infections who require catheter insertion should be
started on antimicrobial treatment prior to catheterisation wherever possible
Catheterised patients with urinary tract infections should be commenced on empirical
treatment prior to catheter changes
5. Choice of prophylactic antimicrobial agent

If available, choice of agent is determined by sensitivities of recent isolate from
catheter urine

Otherwise, give Gentamicin 2mg/kg IV (max 160mg) immediately prior to
catheter change/insertion