From the Guidelines
Catheter-associated urinary tract infections (CAUTIs) in men should be treated with a 7-14 day course of antibiotics when symptomatic, with the specific duration depending on symptom resolution and clinical response, as evidenced by the most recent study 1. When treating CAUTIs in men, it is essential to begin with prompt removal or replacement of the catheter whenever possible, followed by appropriate antibiotic therapy. For empiric treatment, options include:
- Fluoroquinolones (such as ciprofloxacin 500mg twice daily)
- Trimethoprim-sulfamethoxazole (160/800mg twice daily)
- Third-generation cephalosporins Once culture results are available, therapy should be narrowed to the most appropriate antibiotic based on susceptibility testing. The recent study 1 suggests that short-duration courses (5-7 days) may be appropriate for the management of complicated UTI and pyelonephritis, with adequate diagnosis based on clinical response, although more data are needed in men to confirm this. However, another study 2 recommends 7-14 days of antimicrobial treatment for patients with CA-UTI who have prompt resolution of symptoms, and 10–14 days of treatment for those with a delayed response. Given the most recent evidence 1, a 7-day treatment course of either fluoroquinolones or trimethoprim/sulfamethoxazole may be considered non-inferior to the 14-day treatment course for complicated UTI in men. Prevention strategies are equally important and include using catheters only when necessary, maintaining a closed drainage system, ensuring proper insertion technique, and removing catheters as soon as clinically appropriate.
From the Research
Treatment of Catheter-Associated UTI in Men
- Catheter-associated urinary tract infections (CAUTIs) are a common occurrence, and their treatment is crucial to prevent complications such as fever, acute pyelonephritis, bacteremia, and death 3.
- The treatment of CAUTIs in men typically involves the removal or replacement of the urethral catheter and the use of appropriate systemic antibiotics for symptomatic patients 3, 4.
- However, the use of systemic antibiotics for asymptomatic patients is not recommended, as it can lead to the development of resistant organisms and other complications 3, 5.
Prevention of CAUTIs
- The prevention of CAUTIs is crucial, and it can be achieved by minimizing the use of indwelling urinary catheters and removing them as soon as medically possible 6, 7.
- Other preventive measures include the use of closed catheter systems, proper aseptic practices for insertion and maintenance, and the use of antimicrobial-coated catheters 3, 7, 5.
- Educational programs and awareness campaigns can also help reduce the incidence of CAUTIs by promoting best practices among healthcare professionals 4, 7.
Risk Factors for CAUTIs
- The duration of catheterization is a significant risk factor for CAUTIs, and longer-term catheterization should only be undertaken when necessary 4, 7.
- Other risk factors include the type of catheter used, the indication for catheterization, and the presence of underlying medical conditions 4, 7.
- The use of antibiotic-impregnated catheters can reduce the risk of symptomatic CAUTIs and bacteriuria, but their use should be balanced against the potential risks of antibiotic resistance and other complications 4, 5.