From the Guidelines
For a catheter-associated urinary tract infection (CAUTI), empiric antibiotic therapy should include coverage for gram-negative organisms and enterococci, with first-line treatment options including fluoroquinolones, such as levofloxacin 750mg orally daily for 5-7 days, as recommended by the Infectious Diseases Society of America guidelines 1, 2. The choice of antibiotic should be guided by local resistance patterns, patient allergies, and culture results, as CAUTIs often involve multidrug-resistant organisms due to frequent healthcare exposure and previous antibiotic use. Some key points to consider in the management of CAUTI include:
- Obtaining a urine specimen for culture prior to initiating antimicrobial therapy to guide targeted therapy once results are available 3
- Replacing the indwelling catheter if it has been in place for at least 2 weeks and its use cannot be discontinued, as this can help reduce the risk of subsequent CA-bacteriuria and CA-UTI 4
- Considering a 5-day regimen of levofloxacin for patients with mild CA-UTI who are not severely ill, as this may be sufficient for most patients 2
- Tailoring the treatment duration based on the severity of the infection, with 7-14 days recommended for most patients with CA-UTI, regardless of whether the patient remains catheterized or not 2
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris Gentamicin Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the following microorganisms: Pseudomonas aeruginosa, Proteus species (indole-positive and indole-negative), Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter species and Staphylococcus species (coagulase-positive and coagulase-negative) Ciprofloxacin, administered I. V. and /or orally, was compared to a cephalosporin for treatment of complicated urinary tract infections (cUTI) or pyelonephritis in pediatric patients 1 to 17 years of age
Abx choice for UTI with catheter:
- Trimethoprim-sulfamethoxazole: can be used to treat urinary tract infections due to susceptible strains of Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris.
- Gentamicin: can be used to treat serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter species, and Staphylococcus species.
- Ciprofloxacin: can be used to treat complicated urinary tract infections (cUTI) or pyelonephritis. The choice of antibiotic should be based on the susceptibility of the causative organism and local epidemiology and susceptibility patterns. 5, 6, 7
From the Research
Antibiotic Choice for UTI with Catheter
The choice of antibiotic for a urinary tract infection (UTI) with a catheter depends on various factors, including the type of bacteria causing the infection and the patient's medical history.
- According to 8, the recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam.
- For UTIs due to AmpC- β -lactamase-producing Enterobacteriales, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems 8.
- For UTIs due to ESBLs-E coli, treatment oral options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 8.
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides, and fosfomycin 8.
Catheter-Associated Urinary Tract Infections (CAUTI)
CAUTI is a significant healthcare burden, and antibiotic resistance rates are alarmingly high 9, 10, 11.
- Reducing the inappropriate use of catheters and developing novel technologies targeted against multidrug-resistant pathogens may be useful in preventing CAUTI 10.
- Minimizing indwelling device usage and stopping the catheter as soon as medically possible are crucial preventative measures for bacteriuria and infection when device use is required 11.
- Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions 11.
Treatment of Pseudomonas aeruginosa Infections
For severe Pseudomonas aeruginosa infections, a beta-lactam plus an aminoglycoside is the standard treatment, but fluoroquinolones can be used as an alternative 12.