Treatment of Providencia rettgeri Urinary Tract Infection
For Providencia rettgeri UTIs, treatment should be guided by susceptibility testing, with meropenem-vaborbactam or imipenem-cilastatin-relebactam recommended for complicated infections caused by carbapenem-resistant strains, while third-generation cephalosporins remain appropriate for susceptible strains. 1, 2
Initial Antibiotic Selection
- Susceptibility testing should guide final antibiotic selection as resistance patterns vary regionally 1
- Third-generation cephalosporins (such as ceftriaxone) remain an appropriate first-line choice for susceptible P. rettgeri strains 2
- For uncomplicated P. rettgeri UTIs in patients with susceptible strains, treatment should be as short as reasonable, generally no longer than 7 days 1
- For complicated UTIs, treatment duration should be guided by clinical response, with 7-14 days typically recommended 1
Resistance Considerations
- Despite FDA approval for P. rettgeri UTIs, fluoroquinolones (like ciprofloxacin) should not be used as first-line therapy due to increasing resistance and unfavorable risk-benefit ratio 1, 3
- The FDA has issued an advisory warning that fluoroquinolones should not be used to treat uncomplicated UTIs because disabling and serious adverse effects result in an unfavorable risk-benefit ratio 3
- For multidrug-resistant P. rettgeri (approximately 7.2% of cases in recent studies), carbapenems like meropenem may be required 2
- P. rettgeri has shown increasing resistance patterns, with some strains harboring multiple resistance genes including NDM-1, VIM-2, and other β-lactamases 4, 5
Special Populations and Situations
- For elderly patients with P. rettgeri bacteremia (a common presentation), third-generation cephalosporins remain appropriate when susceptibility is confirmed 2
- In patients with urinary catheters (a common risk factor for P. rettgeri infection), consider catheter removal or replacement as part of the treatment strategy 2
- Tailor therapy to the shortest effective duration to mitigate increasing resistance 1
Antimicrobial Stewardship Considerations
- Obtain cultures before initiating antibiotics to enable targeted therapy 1
- Implement antibiotic de-escalation once culture results are available to avoid selecting resistant pathogens 1
- Avoid treating asymptomatic bacteriuria, which increases the risk of developing resistant organisms 1, 3
- Local antibiogram data should guide empiric therapy decisions, as resistance patterns vary geographically 1
Monitoring and Follow-up
- Obtain repeat urine cultures if symptoms persist despite appropriate therapy 1
- Evaluate for structural abnormalities only if recurrent infections occur 1
- Monitor for clinical improvement within 48-72 hours of initiating appropriate antibiotic therapy 2
Common Pitfalls to Avoid
- Using fluoroquinolones empirically without susceptibility testing, as resistance rates have increased significantly 1, 3
- Failing to obtain cultures before initiating antibiotics 1
- Unnecessarily prolonged antibiotic courses, which contribute to resistance development 1, 3
- Treating asymptomatic bacteriuria, which increases risk of developing resistant organisms 1, 3