From the Guidelines
Staphylococcus saprophyticus Urinary Tract Infections (UTIs) are typically treated with oral antibiotics, such as trimethoprim-sulfamethoxazole (160/800 mg twice daily) or ciprofloxacin (250-500 mg twice daily) for 3-5 days in uncomplicated cases 1.
Treatment Options
- For patients with complicated UTIs or those who cannot tolerate oral medications, intravenous ceftriaxone (1-2 grams every 24 hours) or cefepime (1-2 grams every 12 hours) may be considered 1.
- Nitrofurantoin (100 mg twice daily) is an alternative option for 5-7 days, but its use is generally limited to uncomplicated lower urinary tract infections 1.
Considerations
- Local antimicrobial susceptibility patterns, particularly for Escherichia coli, should be considered in empirical antimicrobial selection for uncomplicated UTIs 1.
- The use of trimethoprim-sulfamethoxazole in the preceding 3-6 months is an independent risk factor for trimethoprim-sulfamethoxazole resistance in women with acute uncomplicated cystitis 1.
- Travel outside the United States in the preceding 3-6 months is independently associated with trimethoprim-sulfamethoxazole resistance 1.
Guidelines
- The European Association of Urology (EAU) urological infections guidelines panel recommends evidence-based insights and recommendations for the diagnosis, treatment, and prevention of UTIs and male accessory-gland infections 1.
- The guidelines emphasize the importance of clinical expertise in tailoring treatment decisions for individual patients, taking into consideration patients’ personal values, preferences, and unique circumstances 1.
From the FDA Drug Label
Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below. Adult Patients: Urinary Tract Infections caused by ... Staphylococcus saprophyticus, or ... Acute Uncomplicated Cystitis in females caused by ... Staphylococcus saprophyticus.
Ciprofloxacin is indicated for the treatment of Urinary Tract Infections (UTIs) caused by Staphylococcus saprophyticus in adult patients, including Acute Uncomplicated Cystitis in females. 2
From the Research
Staphylococcus saprophyticus Urinary Tract Infection (UTI)
- Staphylococcus saprophyticus is the second most common bacteria associated with urinary tract infections (UTIs) in women 3
- The antimicrobial treatment regimen for uncomplicated UTI is normally nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or a fluoroquinolone without routine susceptibility testing of S. saprophyticus recovered from urine specimens 3
- However, TMP-SMX-resistant S. saprophyticus has been detected recently in UTI patients, as well as in some cohorts 3
Diagnostic Tests
- The positive predictive value (PPV) and specificity of the nitrite test were high for all samples 4
- A negative nitrite with a positive leucocyte-esterase (LE) test showed a high PPV and sensitivity 4
- When both nitrite and LE tests were negative, approximately 50% of the samples were culture positive 4
Treatment Options
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 5
- Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 5
- For UTIs due to ESBL-producing Enterobacteriaceae, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 5, 6
Antibiotic Resistance
- High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities 5
- The emergence of multidrug-resistant ESBL-producing Enterobacteriaceae restricts significantly the therapeutic options 6
- Pivmecillinam, fosfomycin, and nitrofurantoin may be effective alternatives for treating UTIs caused by ESBL-producing Enterobacteriaceae 6