What is the management of urinary tract infections (UTI) in patients who perform intermittent self-catheterization (ISC)?

From the Guidelines

For patients who self-catheterize and develop a urinary tract infection (UTI), the management should focus on treating symptomatic CA-UTI according to the recommendations for complicated UTI, as stated in the European Association of Urology guidelines 1. The treatment approach should prioritize the use of antimicrobial therapy, with the selection of antibiotics based on local resistance patterns and the results of urine cultures.

• The European Association of Urology guidelines recommend treating symptomatic CA-UTI according to the recommendations for complicated UTI, which includes the use of antibiotics such as trimethoprim-sulfamethoxazole, nitrofurantoin, or ciprofloxacin 1.
• It is also recommended to take a urine culture before initiating antimicrobial therapy in catheterized patients whose catheter has been removed, to guide the selection of antibiotics 1.
• Additionally, the guidelines suggest replacing or removing the indwelling catheter before starting antimicrobial therapy, to reduce the risk of catheter-associated UTI 1.
• Patients who self-catheterize should be advised to self-catheterize at regular intervals to avoid bladder overdistension, and to obtain urine cultures before starting antibiotics when possible, as patients who self-catheterize often have resistant organisms or polymicrobial infections requiring targeted therapy.
• The use of hydrophilic coated catheters is also recommended to reduce CA-UTI, as stated in the European Association of Urology guidelines 1.
• Furthermore, the guidelines advise against the routine use of antibiotic prophylaxis to prevent clinical UTI after urethral catheter removal or in patients performing intermittent self-catheterization, unless there is a history of recurrent UTIs or other specific indications 1.

From the Research

Management of UTI for Patients who Self-Catheterize

• The management of urinary tract infections (UTIs) in patients who self-catheterize involves the use of antimicrobial therapy, with the choice of antibiotic depending on the severity of the infection and the presence of any underlying medical conditions 2, 3, 4.
• For acute uncomplicated UTIs, first-line treatment options include nitrofurantoin, fosfomycin, and pivmecillinam, while second-line options include oral cephalosporins, fluoroquinolones, and β-lactams such as amoxicillin-clavulanate 2.
• Nitrofurantoin has been shown to be effective in preventing UTIs, with a systematic review and meta-analysis demonstrating its efficacy and safety as prophylaxis for UTIs 5.
• The clinical efficacy of nitrofurantoin for treating uncomplicated UTIs in adults has been investigated in several randomized control trials, with results suggesting that it is at least comparable to other treatments in terms of efficacy 6.
• Patients with UTIs caused by multidrug-resistant organisms, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, may require alternative treatment options, including parenteral antibiotics such as carbapenems and ceftazidime-avibactam 2.
• The use of antimicrobial therapy in patients who self-catheterize should be guided by local susceptibility patterns and the results of urine culture and sensitivity testing, in order to minimize the risk of antibiotic resistance and ensure effective treatment of UTIs 2, 3, 4.

Treatment Options for UTIs in Patients who Self-Catheterize

• Nitrofurantoin: effective for preventing UTIs and treating uncomplicated UTIs 5, 6
• Fosfomycin: effective for treating uncomplicated UTIs and UTIs caused by ESBL-producing Enterobacteriaceae 2
• Pivmecillinam: effective for treating uncomplicated UTIs and UTIs caused by ESBL-producing Enterobacteriaceae 2
• Oral cephalosporins: effective for treating uncomplicated UTIs and UTIs caused by ESBL-producing Enterobacteriaceae 2
• Fluoroquinolones: effective for treating uncomplicated UTIs and UTIs caused by ESBL-producing Enterobacteriaceae, but may be associated with increased risk of antibiotic resistance 2, 4
• β-lactams: effective for treating uncomplicated UTIs and UTIs caused by ESBL-producing Enterobacteriaceae, but may be associated with increased risk of antibiotic resistance 2, 4

Special Considerations for Patients who Self-Catheterize

• Patients with UTIs caused by multidrug-resistant organisms may require alternative treatment options, including parenteral antibiotics 2
• Patients with frequent recurrent UTIs may require long-term antimicrobial prophylaxis or intermittent self-catheterization 4
• Patients with underlying medical conditions, such as diabetes or immunosuppression, may be at increased risk of developing UTIs and may require more aggressive treatment 2, 4