What is the intravenous (IV) treatment for catheter-associated urinary tract infection (CAUTI)?

From the Guidelines

For catheter-associated urinary tract infections (CAUTIs) requiring intravenous treatment, a 7-14 day regimen of antimicrobial treatment is recommended, with the option of a 5-day regimen of levofloxacin for patients who are not severely ill 1. The choice of antibiotic should be based on the severity of the infection, the patient's risk factors for resistant organisms, and local antimicrobial resistance patterns.

• Broad-spectrum antibiotics like ceftriaxone, cefepime, or piperacillin-tazobactam may be used as empiric therapy, with consideration of carbapenems such as meropenem for patients with risk factors for resistant organisms.
• Treatment should be tailored based on urine culture results and antibiotic susceptibility testing, with adjustment of the regimen as necessary to ensure effective treatment.
• Removal of the urinary catheter should be performed as soon as clinically feasible, as this significantly improves treatment outcomes, and if the catheter must remain, it should be replaced before initiating antibiotic therapy to remove the biofilm that harbors bacteria 1.
• Patients should be monitored for clinical improvement, including resolution of fever, decreased white blood cell count, and improved urinary symptoms, and hydration should be maintained throughout treatment.
• A shorter course of treatment, such as a 3-day regimen, may be considered for younger women with mild CA-UTI after the catheter has been removed, but this should be done with caution and careful monitoring of the patient's response to treatment 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Catheter-Associated UTI IV Treatment

• The treatment of catheter-associated urinary tract infections (CAUTIs) often involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the patient's medical history 2.
• In cases of serious CAUTI, empirical antibiotic treatment should be initiated with activity against multiresistant uropathogens 2.
• The use of combination therapy, such as a beta-lactam plus an aminoglycoside or a fluoroquinolone, may be effective against Pseudomonas aeruginosa, a common cause of CAUTIs 3.
• However, the choice of antibiotic should be guided by susceptibility testing and clinical judgment, as the development of antibiotic resistance is a major concern in the treatment of CAUTIs 4, 5.

Prevention of CAUTIs

• The most efficient methods to prevent CAUTIs are to avoid unnecessary catheterizations and to remove catheters as soon as possible 2.
• The use of different reminder systems and implementation of infection control programs can effectively decrease CAUTIs, although their introduction can be challenging 2.
• The use of hydrophilic-coated catheters for clean intermittent catheterization can effectively reduce infections, and preliminary results with chlorhexidine-coated catheters are promising 2.

Diagnosis and Treatment

• The diagnosis of CAUTIs typically involves the analysis of urine samples, and treatment should be guided by the results of susceptibility testing 6, 5.
• Novel diagnostic strategies and treatment decision aids, such as biomarkers and artificial intelligence algorithms, are being developed to improve the diagnosis and treatment of CAUTIs 4.