What is the treatment for a male patient with a urinary tract infection (UTI) caused by negative Staphylococcus, specifically coagulase-negative Staphylococcus (CoNS)?

From the Guidelines

For treating a negative staphylococcus male UTI, the recommended treatment approach should prioritize addressing the underlying complicating factors and using antimicrobial therapy based on local resistance patterns and specific host factors, with a treatment duration of 7-14 days. When considering the treatment of male UTIs, especially those involving Staphylococcus species, it's crucial to recognize that these infections can be complicated due to factors such as obstruction, recent instrumentation, or the presence of multidrug-resistant organisms 1. Given the potential for antimicrobial resistance, especially in complicated UTIs, initial empiric therapy should be guided by local resistance patterns and subsequently tailored based on urine culture and susceptibility testing results 1. Key considerations include:

• The microbial spectrum in complicated UTIs is broader, including organisms like E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1.
• Treatment duration can vary from 7 to 14 days, depending on the severity of the illness and whether prostatitis can be excluded, with longer durations often necessary for men to ensure adequate coverage of potential prostate involvement 1.
• Optimal antimicrobial therapy should be chosen based on the severity of the illness, local resistance patterns, and specific host factors, such as allergies, and should be adjusted according to urine culture and susceptibility testing results 1. In clinical practice, ensuring the patient is haemodynamically stable and afebrile for at least 48 hours may allow for consideration of shorter treatment durations, but this should be approached with caution and based on individual patient factors and response to treatment 1. Ultimately, the goal of treatment is to effectively eradicate the infection while minimizing the risk of antimicrobial resistance and ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.

From the Research

Treatment Options for Negative Staphylococcus Male UTI

• The use of trimethoprim-sulfamethoxazole has been reported to be effective in treating urinary tract infections caused by Staphylococcus species, including Staphylococcus haemolyticus 2.
• Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are commonly used antimicrobials for urinary tract infections, and are active in vitro against usual aerobic gram-negative bacteria 3.
• Ciprofloxacin has been shown to be effective in treating urinary tract infections, including those caused by Escherichia coli, and has a well-known safety profile 4, 5.
• Ciprofloxacin extended release is a once-daily formulation that has been shown to be at least as effective as twice-daily ciprofloxacin, with similar tolerability and side-effect profiles 4.
• A study comparing ciprofloxacin and trimethoprim-sulfamethoxazole for the treatment of community-acquired urinary tract infections found that both treatments were equally effective, but ciprofloxacin was associated with fewer adverse reactions 5.

Considerations for Treatment

• The choice of antibiotic should be based on the susceptibility of the causative organism, as well as the patient's medical history and potential allergies 3, 5.
• The emergence of antimicrobial resistance is a concern, and the use of antibiotics should be guided by local resistance patterns and treatment guidelines 4.
• Patient compliance is an important factor in the success of treatment, and once-daily formulations such as ciprofloxacin extended release may improve compliance and reduce the development of antimicrobial resistance 4.