An asymptomatic 70-year-old woman admitted with hip fracture has had an indwelling urinary catheter for 6 days. Routine surveillance urine culture grows Escherichia coli at 10^5 CFU/mL. She is afebrile with no flank pain. What is the correct management?

• A Start nitrofurantoin for 7 days and remove the catheter
• B Treat with ceftriaxone intravenously to prevent urosepsis
• C Send a repeat culture and treat only if the count exceeds 10^6 CFU/mL
• D No antimicrobial therapy; remove the catheter only if it is no longer indicated ✓

Explanation

Asymptomatic bacteriuria in a catheterised patient is almost universal with prolonged catheterisation and must not be treated, because antibiotics select resistant strains without reducing symptomatic infection or mortality. The only widely accepted exception is screening and treatment before invasive urological procedures that breach mucosa. Nitrofurantoin achieves poor tissue levels and is inappropriate here, and raising the treatment threshold misses the point that absence of symptoms, not the colony count, drives the decision.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.