NHSN CAUTI: But Wasn't the Fever From Something Else?
The Question
A patient has a qualifying indwelling urinary catheter, a qualifying urine culture, and a fever greater than 38°C. But the patient also has another diagnosis that could reasonably explain the fever.
Can the fever be excluded from the NHSN CAUTI definition because it is believed to be caused by something else?
The Case
Hospital Day 1
A patient is admitted and has an indwelling urinary catheter placed.
Hospital Day 3
The patient develops a fever of 38.6°C and respiratory symptoms and subsequently tests positive for influenza A.
Hospital Day 4
A urine culture was collected, which grew >100,000 CFU/mL Escherichia coli.
The Foley has been in place for more than 2 consecutive days and is still present on the date of event. No suprapubic tenderness or CVA pain/tenderness is documented.
What Do You Think?
The patient has a qualifying Foley, a urine culture growing >100,000 CFU/mL E. coli, and a fever of 38.6°C.
But the patient was diagnosed with influenza A the day before.
Does this meet NHSN criteria for a CAUTI?
Yes
No - the fever can be attributed to influenza
Not enough information
Reveal the Answer
Answer: Yes.
For NHSN surveillance, the fever still counts.
The 2026 NHSN UTI checklist and NHSN's Urinary Tract Infection chapter specifically state that "Fever and hypothermia are non-specific symptoms of infection and cannot be excluded from UTI determination because they are clinically deemed due to another recognized cause."
Walking Through the Definition
For SUTI 1a CAUTI, the patient has to meet all three major parts of the NHSN definition.
Was the catheter timing met? Yes.
The indwelling urinary catheter had been in place for more than 2 consecutive days in an inpatient location and was still present on the date of event. That satisfies the device-association requirement.
Was the urine culture eligible? Yes.
The urine culture grew >100,000 CFU/mL E. coli. NHSN requires a urine culture with no more than two species of organisms identified, with at least one bacterium present at ≥100,000 CFU/mL.
Was there a qualifying sign or symptom? Yes.
The patient had a fever of 38.6°C. For a SUTI 1a, a fever >38.0°C is a qualifying symptom.
And here is the key point for this case: NHSN specifically states that "Fever and hypothermia are non-specific symptoms of infection and cannot be excluded from UTI determination because they are clinically deemed due to another recognized cause."
One More Important Detail
Because the Foley was still in place, urinary urgency, urinary frequency, and dysuria could not be used as qualifying symptoms for this event. NHSN excludes those symptoms while an indwelling urinary catheter is present because the catheter itself can cause those complaints.
So Where Does That Leave Us?
The patient had:
a qualifying indwelling urinary catheter
a qualifying urine culture
a qualifying fever
all required elements occurring within the appropriate NHSN timeframe.
The SUTI 1a CAUTI definition is met.
