What is the recommended treatment for Pseudomonas putida Urinary Tract Infection (UTI)?

Treatment of Pseudomonas putida Urinary Tract Infection

For Pseudomonas putida urinary tract infections, fluoroquinolones such as levofloxacin or ciprofloxacin are recommended as first-line therapy when susceptibility is confirmed, with aminoglycosides as an alternative option for uncomplicated urinary tract infections. 1, 2

Initial Assessment and Diagnosis

• Obtain a urine culture and susceptibility testing before initiating antimicrobial therapy to guide treatment decisions due to the wide spectrum of potential infecting organisms and increased likelihood of antimicrobial resistance 1
• Pseudomonas putida, like other Pseudomonas species, is commonly found in complicated UTIs and may demonstrate resistance to multiple antibiotics 1
• Consider whether the infection is complicated (presence of structural abnormalities, foreign bodies, immunosuppression) or uncomplicated, as this affects treatment approach 1

Treatment Recommendations

First-line Treatment Options:

• Fluoroquinolones (when local resistance rates are <10%):
  • Levofloxacin 750 mg orally once daily for 5-10 days 2
  • Ciprofloxacin 400 mg IV every 8 hours or 500-750 mg orally twice daily for 7-14 days 1, 3
  • Note: Fluoroquinolones should be avoided if the patient has used them in the last 6 months or comes from a urology department with high resistance rates 1

Alternative Treatment Options:

• For complicated UTI with systemic symptoms:

  • Combination therapy with amoxicillin plus an aminoglycoside 1
  • A second-generation cephalosporin plus an aminoglycoside 1
  • An intravenous third-generation cephalosporin 1

• For DTR-PA (difficult-to-treat Pseudomonas) or carbapenem-resistant strains:

  • Colistin monotherapy or combination therapy 1
  • Ceftolozane/tazobactam 1.5-3 g IV every 8 hours 1
  • Ceftazidime/avibactam 2.5 g IV every 8 hours 1
  • Imipenem/cilastatin/relebactam 1.25 g IV every 6 hours 1

• For uncomplicated UTI (when susceptible):

  • Aminoglycoside monotherapy is indicated for urinary tract infections 1
  • Amikacin 15 mg/kg IV once daily 1

Duration of Treatment:

• For complicated UTI: 7-14 days (14 days for men when prostatitis cannot be excluded) 1
• For uncomplicated UTI: 5-7 days 1
• When the patient is hemodynamically stable and has been afebrile for at least 48 hours, a shorter treatment duration (7 days) may be considered 1

Special Considerations

Catheter-Associated UTI:

• If an indwelling catheter has been in place for ≥2 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced to hasten symptom resolution and reduce the risk of subsequent CA-bacteriuria and CA-UTI 1
• Obtain urine culture specimens from freshly placed catheters prior to initiating antimicrobial therapy 1

Antimicrobial Stewardship:

• Use nitrofurantoin when possible for re-treatment of non-Pseudomonas UTIs since resistance is low and decays quickly 1
• Avoid classifying patients with recurrent UTI as "complicated" as this often leads to use of broad-spectrum antibiotics with long durations of treatment 1
• Avoid treatment of asymptomatic bacteriuria in patients with recurrent UTI 1

Monitoring and Follow-up

• Culture and susceptibility testing performed periodically during therapy will provide information about continued susceptibility of the pathogens and possible emergence of bacterial resistance 2
• If a patient has persistent symptoms despite treatment, repeat the urine culture to assess for ongoing bacteriuria before prescribing additional antibiotics 1
• For patients with recurrent UTIs, consider prophylactic strategies after completing the acute treatment course 1

Treatment Efficacy

• Studies have shown high efficacy rates (>80%) for ciprofloxacin in treating complicated UTIs caused by Pseudomonas species 4, 3
• In one study, ciprofloxacin eradicated Pseudomonas from the urine of all patients during therapy, with 89% still clear 5-9 days after treatment 3
• Levofloxacin has demonstrated higher microbiologic eradication rates compared to ciprofloxacin in catheterized patients (79% vs 53%) 1