In this PPT I am discussing about post-operative fever on POD#3. This is commonly due to catheter associated urinary tract infection- CA-UTI. The cause is keeping urinary catheter too long. I am discussing about how to diagnose this problem and how to manage it. you can watch all my teaching videocasts in the following links: surgicaleducator.blogspot.com

1. CASE BASED
LEARNING
POSTOPERATIVE FEVER
POD# 3=Water
Dr.B.Selvaraj MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia

2. CASE BASED
LEARNING
65 years old women developed fever on 3rd post-operative day
after she underwent radical subtotal gasrectomy for cancer in
antral region of stomach
O/E: The urine in Foley's catheter appeared cloudy and patient
had fever also. Incision site was clear, dry, and intact. Lungs- clear
 Vitals: BP: 110/57 mms of Hg; PR: 110/min
RR: 16 breaths/min T: 100.4*F

3. CASE BASED LEARNING
 What is your diagnosis?
 Fever in postop day 3 to 5 is due to CA-UTI. Foley’s catheter is
a foreign body and therefore is a nidus for infection.
Mnemonic:
 Wind – POD # 1 to 3  Atelectasis & Pneumonia
 Water – POD # 3 to 5 CA- UTI
 Walking- POD# 4 to 8 DVT & PE
 Wound-POD# 5 to 7 SSI
 Wonder drugs- anytime  Drug fever

4. CA- UTI
 What is the best next step?
- Remove the catheter and do urinalysis and urine culture. Many
hospitals have well-established protocols for early removal or
avoidance of catheters
-The most common organisms are E.Coli and enterococci
-Common misconceptions regarding prevention of CAUTI include
prophylactic antibiotics, using iodine-based sterile techniques for
insertion, and flushing the catheter. The only definitive way of
preventing a CAUTI is early removal of the catheter.

5. CA- UTI
 UTIs tend to occur slightly later in a typical postoperative course
(usually POD #3 and beyond), but can occur at any time. They are
common in patients who have had a Foley catheter in place pre or
post surgery. For this reason, urinary catheters are removed as soon
as possible after surgery.
 Symptoms of dysuria and frequency are not always present.
 U/A (looking for WBCs) and urine cultures should be part of any
postoperative fever workup. Urinalysis showing more than 10*5
colony forming units (CFU)/mL in a non catheterized patient and
more than 10*3 CFU/mL in a catheterized patient indicates UTI.
 Urine Leukocyte esterase & nitrites are surrogate markers for
WBCs in the urine.

6. CA- UTI
 UTI is a common postoperative event and a significant source of
morbidity in postsurgical patients.
 A major predisposing factor is the presence of a urinary catheter;
the risk increases with increased duration of catheterization (>2
days).
 Endogenous bacteria (colonic flora, most common E. coli) are the
most common source of catheter-related UTI in patients with
short-term catheterization.
 Additional bacteria are found with prolonged catheterization.
 In a critically ill surgical patient, candiduria accounts for
approximately 10% of nosocomial UTIs.

7. CA- UTI
 Prevention of UTI starts with minimizing the duration of
catheterization and maintenance of a closed drainage system.
 When prolonged catheterization is required, changing the catheter
before blockage occurs is recommended because the catheter
serves as a site for pathogens to create a biofilm
 UTI is treated with removal or replacement of the catheter with a
new one.
 Empirical broad-spectrum antibiotics are started because most
offending organisms exhibit resistance to several antibiotics and
then tailored according to culture and sensitivity results.
 Patients with candiduria are managed with IV Flucanazole

8. THANK YOU
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