From the Guidelines
The recommended treatment for a urinary tract infection (UTI) caused by Pseudomonas aeruginosa is ceftolozane/tazobactam 1.5-3 g IV q8h or ceftazidime/avibactam 2.5 g IV q8h for 5-14 days, as these novel β-lactam agents are currently the first-line options for targeted treatment of difficult-to-treat Pseudomonas aeruginosa (DTR-PA) infections 1.
Treatment Options
- For UTIs caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) susceptible to other antimicrobial agents, treatment options include piperacillin/tazobactam, ceftazidime, cefepime, cefpirome, ciprofloxacin, or levofloxacin 1.
- For DTR-PA infections, colistin monotherapy or combination therapy may be considered, in addition to ceftolozane/tazobactam or ceftazidime/avibactam 1.
Duration of Treatment
- The suggested treatment duration is 5-10 days for complicated urinary tract infections and 10-14 days for hospital-acquired or ventilator-associated pneumonia and bloodstream infection 1.
Important Considerations
- Obtaining urine cultures and susceptibility testing is crucial to guide therapy, as Pseudomonas aeruginosa is naturally resistant to many antibiotics 1.
- Adequate hydration is important during treatment to help flush bacteria from the urinary tract.
- For recurrent Pseudomonas UTIs, investigation for structural abnormalities, foreign bodies (like catheters), or immunocompromised status is warranted.
From the Research
Treatment Options for UTI caused by Pseudomonas aeruginosa
- The recommended treatment for a urinary tract infection (UTI) caused by Pseudomonas aeruginosa includes fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, and fosfomycin 2
- Ciprofloxacin has been shown to be effective in treating UTIs caused by Pseudomonas aeruginosa, with a cure rate of 64% at one month follow-up 3
- Other fluoroquinolones, such as levofloxacin, have also been shown to be active against Pseudomonas aeruginosa, with activity comparable to ciprofloxacin 4, 5
- Combination therapy, such as piperacillin/tazobactam with amikacin, ciprofloxacin, or trovafloxacin, may also be effective against Pseudomonas aeruginosa 6
Considerations for Treatment
- The choice of treatment should be based on local susceptibility patterns and the severity of the infection 2
- High rates of resistance to certain antibiotics, such as trimethoprim-sulfamethoxazole and ciprofloxacin, may limit their use as empiric treatment options 2
- The use of new antimicrobials should be done wisely to avoid the development of resistance 2