Does Jardiance Cause Staphylococcus aureus UTIs?
Jardiance (empagliflozin) does not specifically cause Staphylococcus aureus UTIs, but like other SGLT2 inhibitors, it increases the overall risk of urinary tract infections, predominantly with typical uropathogens like E. coli rather than S. aureus. 1
Understanding the UTI Risk with SGLT2 Inhibitors
SGLT2 inhibitors like empagliflozin increase urinary glucose excretion, which theoretically creates a more favorable environment for bacterial growth in the urinary tract. However, the microbiology of these infections follows predictable patterns:
Typical Uropathogens in UTIs
The most common organisms causing UTIs, including in patients with diabetes (a risk factor for complicated UTIs), are 2:
- E. coli (approximately 75% of cases)
- Proteus species
- Klebsiella species
- Pseudomonas species
- Serratia species
- Enterococcus species
Staphylococcus aureus is notably absent from this list of common uropathogens and represents an unusual cause of primary UTI 2.
When S. aureus Causes UTI
S. aureus UTIs are uncommon and typically occur through hematogenous seeding rather than ascending infection 3. Risk factors for primary S. aureus UTI include 3:
- Recent or concurrent hospitalization
- Urinary tract catheterization
- Recent phlebitis or intravenous catheter-related infections
- Healthcare-related exposures
These risk factors suggest S. aureus reaches the urinary tract through the bloodstream from other infection sites, not through the typical ascending route that would be influenced by increased urinary glucose 3.
Clinical Guidance for SGLT2 Inhibitor Use
Patient Selection Considerations
The American Diabetes Association recommends caution with SGLT2 inhibitors in specific populations 1:
- Patients with recurrent UTIs (≥3 episodes/year or 2 in last 6 months)
- Patients with severe UTIs requiring hospitalization
- Older adults at greater risk for complications
- Patients with urinary incontinence (due to increased urine volume)
Risk-Benefit Assessment
The UTI risk should be weighed against the substantial cardiovascular and renal benefits of empagliflozin, particularly in patients with heart failure or chronic kidney disease 1. The cardiovascular mortality reduction demonstrated in clinical trials often outweighs the increased UTI risk in appropriately selected patients 4, 5.
Monitoring Strategy
Rather than avoiding empagliflozin due to UTI concerns, appropriate patient selection and vigilant monitoring are key 1:
- Screen for history of recurrent UTIs before initiation
- Educate patients about UTI symptoms
- Promptly evaluate and treat any suspected UTIs
- Consider discontinuation if recurrent infections develop
Special Populations
Catheterized Patients
A 2024 study found no statistically significant difference in UTI rates when comparing catheter use alone versus concurrent catheter and empagliflozin use (0.09 UTIs/month pre-empagliflozin vs 0.07 post-empagliflozin, P=0.61) 6. This suggests that even in high-risk catheterized patients, empagliflozin may not substantially increase UTI risk beyond baseline.
Fungal Infections
While rare, fungal UTIs (particularly Candida species) represent a more relevant concern than S. aureus with SGLT2 inhibitors due to the glycosuria promoting fungal growth 7. Serious fungal infections requiring surgical intervention have been reported 7.
Clinical Bottom Line
If a patient on Jardiance develops a S. aureus UTI, investigate for alternative sources of bacteremia (intravascular catheters, skin infections, endocarditis) rather than attributing it to the medication 3. The S. aureus is likely reaching the urinary tract hematogenously from another primary infection site, not as a direct consequence of the SGLT2 inhibitor mechanism 3.