Urinary Catheterisation in Adults - Antimicrobial Prophylaxis During

Publication: 30/11/2010  
Next review: 01/05/2026  
Clinical Guideline
ID: 1878 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2023  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Antimicrobial Prophylaxis During Urinary Catheterisation in Adults

Urinary catheters increase the risk of urinary tract infection and sepsis. The risk/benefit of catheterisation varies with the different patient groups. All catheters should be reviewed daily and removed at the earliest opportunity.

Catheters should be removed as soon as they are no longer needed and avoid any unnecessary cathetherisation. 
Contact Microbiology to discuss appropriate alternative if the patient has gentamicin resistant organisms and/or allergy.


ALL PATIENTS: check previous Microbiology results for Gentamicin resistance.

Catheterisation factors

Patient factors / reason for catheterisation

Antimicrobial dose/route
Give within 1 hour before catheter manipulation

Situations where prophylaxis is needed or should be risk assessed for


Painless (chronic) urinary retention

Gentamicin 1.5mg/kg IV or IM single dose

Insertion or removal

<6 weeks post joint replacement surgery


Post prostatic surgery

Removal or change

Discharge at the exit site or meatus

Change: traumatic

2 or more attempts required when inserting the new catheter or trauma has occurred (frank haematuria)

If catheterisation has failed at the 1st attempt, prophylaxis should be given prior to the next attempt. If prophylaxis was not indicated prior to catheterisation and trauma occurs, give antibiotic dose immediately after catheterisation.

Removal or change

Long term catheter blockage in a male patient residing in a care home

Removal or change

MSSA or MRSA isolated from the exit site or meatus in the previous 12 months

Removal or change

Other patient factors that may increase the risk of developing catheter associated infection are:

  • Severe immunosuppression,
  • Male sex,
  • Abnormal urinary tract
  • Multiple co-morbidities

Individual risk assessment is advised; where there are 2 or more of these risk factors present prophylaxis is advised.



Insert after routine surgical prophylaxis for the procedure being undertaken

Situations where treatment for infection is required

Removal or change

Symptomatic UTI

Treat as per CA-UTI guideline


Painful (acute) urinary retention: symptomatic UTI

Treat as per lower UTI guideline (or upper UTI if evidence of urosepsis)

Situations where prophylaxis is not required


Painful (acute) urinary retention: no symptoms of UTI


Fluid monitoring.
Remove at the earliest opportunity


Catheters should not be routinely used for incontinence management

Intermittent self-catheterisation (ISC)


Suprapubic cathether

Insertion, removal or change

Risk factors for infective endocarditis

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Record: 1878
Clinical condition:
Target patient group: Any patient undergoing manipulation (insertion/change/removal) of a urinary catheter
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  • NICE infection prevention and control quality standard [QS61], published 17 April 2014
  • Urological infections guideline, European Association of Urologists, 2022 update
  • Catheterisation Indwelling catheters in adults - Urethral and Suprapubic, European Association of Urology Nurses, 2012
  • NICE. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. NICE clinical guideline 64: National Institute for Health and Clinical Excellence, 2008. Updated 2016
  • NIE. Healthcare-associated infections: prevention and control in primary and community care.  Clinical guideline [CG139]. 2012, updated Feb 2017

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Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 1.0

Related information

Not supplied

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