Treatment for UTI Causing Urinary Retention
For a UTI causing urinary retention, the standard treatment includes catheterization to relieve obstruction followed by empiric antimicrobial therapy with either amoxicillin plus an aminoglycoside, a second-generation cephalosporin plus an aminoglycoside, or an intravenous third-generation cephalosporin. 1
Initial Management
- Immediate bladder catheterization with complete decompression is essential to relieve the urinary retention 1, 2
- If the indwelling catheter has been in place for ≥2 weeks, it should be replaced before starting antimicrobial therapy to hasten symptom resolution and reduce the risk of subsequent infection 1
- Obtain a urine culture prior to initiating antibiotics due to the wide spectrum of potential pathogens and increased likelihood of antimicrobial resistance 1
- Suprapubic catheterization may be superior to urethral catheterization for short-term management as it improves patient comfort and decreases bacteriuria 1, 3
Antimicrobial Therapy for Complicated UTI with Urinary Retention
First-line options (Strong recommendation):
- Combination therapy with one of the following 1:
- Amoxicillin plus an aminoglycoside
- A second-generation cephalosporin plus an aminoglycoside
- An intravenous third-generation cephalosporin
Alternative options:
- Ciprofloxacin may be used only if 1:
- Local resistance rate is <10%
- Treatment can be given entirely orally
- Hospitalization is not required
- Patient has anaphylaxis to β-lactam antimicrobials
- Do not use fluoroquinolones if the patient has used them in the last 6 months 1
Duration of Treatment
- 7 days for patients with prompt symptom resolution 1
- 10-14 days for patients with delayed response 1
- 14 days for men when prostatitis cannot be excluded 1
- Duration may be shortened to 7 days when the patient is hemodynamically stable and has been afebrile for at least 48 hours 1
Special Considerations
- Urinary retention with UTI is considered a complicated UTI, with a broader microbial spectrum than uncomplicated UTIs 1
- Common pathogens include E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1
- Addressing the underlying cause of urinary retention is mandatory for effective treatment 1, 3
- For catheter-associated UTI, silver alloy-impregnated catheters may help reduce infection rates 1, 2
- For patients with chronic retention from neurogenic bladder, clean intermittent self-catheterization should be taught 2
Treatment Adjustments
- Adjust empiric therapy based on culture and susceptibility results 1
- Follow with oral antimicrobial therapy appropriate for the identified pathogen 1
- For multidrug-resistant organisms, newer agents like ceftazidime-avibactam, meropenem-vaborbactam, or imipenem-cilastatin-relebactam may be considered 1
Common Pitfalls to Avoid
- Failing to replace indwelling catheters that have been in place for ≥2 weeks before starting antibiotics 1
- Using fluoroquinolones empirically in patients from urology departments or those who have used them in the past 6 months 1
- Not obtaining urine cultures before initiating antimicrobial therapy 1
- Treating asymptomatic bacteriuria rather than true UTI 4
- Neglecting to address the underlying cause of urinary retention 1, 3
Remember that urinary retention with UTI requires both relief of the obstruction and appropriate antimicrobial therapy to effectively treat the infection and prevent complications such as urosepsis 1, 3.