Cloudy urine, foul odor, pyuria, and bacteriuria are common in patients with long-term catheters. They do not, by themselves, establish a symptomatic infection. Biofilm and colonization make asymptomatic bacteriuria likely, which is why routine surveillance cultures are discouraged. Assess for a compatible clinical picture: fever of 38°C (100.4°F) or higher, suprapubic discomfort, flank pain or costovertebral-angle tenderness, rigors, or new dysuria after catheter removal. New altered mental status requires prompt assessment, especially when accompanied by fever, hemodynamic instability, or other signs of systemic illness, but confusion alone should not automatically be attributed to CAUTI. Evaluate for other causes such as hypoxia, medication effects, dehydration, pain, constipation, or another infection source. When a urine culture is clinically indicated, obtain a fresh specimen aseptically from the sampling port—not from the drainage bag. Disinfect the port and use the facility-approved sterile collection method. If catheter replacement is clinically indicated, collect the specimen from the newly placed catheter system rather than from old, colonized tubing. A patient with fever and a catheter may have pneumonia, a line infection, surgical infection, medication fever, or another...