From the Guidelines
Levofloxacin is the most appropriate antibiotic for treating Catheter-Associated Urinary Tract Infections (CAUTI).
Treatment Duration and Antibiotic Choice
- A 7-14 day regimen is recommended for most patients with CA-UTI, regardless of whether the patient remains catheterized or not 1.
- A 5-day regimen with levofloxacin is likely to be sufficient for most patients with mild CA-UTI 1.
- Moxifloxacin should be avoided for the treatment of UTI because of uncertainty regarding effective concentrations in urine 1.
- Ciprofloxacin may also be considered, but data on its use is less clear compared to levofloxacin 1.
Important Considerations
- The use of the urinary catheter should always be discontinued as soon as appropriate 1.
- Urine cultures are recommended prior to treatment to confirm that an empirical regimen provides appropriate coverage and to allow tailoring of the regimen on the basis of antimicrobial susceptibility data 1.
- Catheter replacement prior to antimicrobial treatment for CA-UTI is recommended if the catheter has been in place for at least 2 weeks and its use cannot be discontinued 1.
From the Research
Antibiotics for Treating CAUTI
- The choice of empirical antibiotic therapy for CAUTI is based on the stratification into complicated and uncomplicated, as well as upper and lower infections, and on specific risk factors, such as urinary tract catheter, as stated in the S3 guideline urinary tract infection 2.
- Antibiotic prophylaxis with Levofloxacin (LVFX) has been shown to be effective in preventing catheter-associated UTIs in short and medium-term catheterizations 3.
- The use of antibiotics with a narrow spectrum of activity and little collateral damage is recommended to prevent the development of resistance and complications 2.
- Current CAUTI management paradigms and challenges are discussed, and future prospects for diagnosis, prevention, and treatment are explored, including novel diagnostic strategies and treatment decision aids, as well as new preventive strategies such as catheter coatings and materials, vaccination, and bacterial interference 4.
Specific Antibiotics
- Levofloxacin (LVFX) has been shown to be useful for preventing short and medium-term CAUTIs 3.
- Ciprofloxacin has been compared to LVFX in the prevention of CAUTIs, with similar results 3.
- The antibiotic pipeline remains insufficient, and new strategies for the identification of new classes of antibiotics, and rational design of small molecule inhibitor alternatives, are under development for CAUTI treatment 4.
Considerations
- Asymptomatic bacteriuria is not a clinically significant condition in men and nonpregnant women, and treatment is unlikely to confer clinical benefit 5.
- The distinction between catheter-associated asymptomatic bacteriuria (CAABU) and CAUTI is important, and better recognition of CAABU may play a key role in reducing unneeded antibiotic usage in hospitalized patients 5.