UTI After Repeated Catheterizations

Patient Presentation
E.O., a twenty year old female, was admitted to the general surgical floor following a small bowel resection for surgical management of Crohn’s. She had a Foley placed in the OR, which was removed at 0600 on post-op day two. E.O. was unable to void independently eight hours after the Foley was removed, despite receiving a fluid bolus of 500ml NS. A bladder scan showed 600ml in her bladder. She was straight cathed, which yielded an output of 575ml. For the next few hours she noted a decrease in urgency, pressure, and pain, but after four hours she became increasingly uncomfortable again. Eight hours after the straight cath was done, E.O. was still unable to void. She complained of pressure and pain. No bolus was given this time, and her bladder scan showed 525ml. A Foley catheter was placed overnight. In the morning, the Foley was ordered to be removed. The nurse emptied the Foley before removing it, and noted a foul smell. E.O. was still unable to void that afternoon, though she frequently had the urge.

Differential List
UTI, pyelonephritis

Diagnosis
An additional Foley catheter was inserted, and a clean catch specimen was obtained. A urinalysis and a urine culture were sent to the lab. The UA came back positive for bacteria and for leukocyte esterase and the culture eventually came back positive for E. coli.

Treatment
E.O. was diagnosed with a UTI, and was placed on amoxicillin. Her Foley was left in for the next 36 hours, to avoid further irritation to her urethra.

Outcome
When the final Foley was removed, E.O. had been on amoxicillin for almost two days. She was able to void independently six hours after Foley discontinuation, with minimal discomfort. Her symptoms continued to resolve, and she finished her course of antibiotics.