From the Guidelines
For an 88-year-old patient with stage V chronic kidney disease and Pseudomonas in the urine with a suprapubic catheter, treatment is not recommended if the patient is asymptomatic, as the benefits of antimicrobial therapy are uncertain and there is high-quality evidence of harm, including adverse effects and increasing the risk of antimicrobial-resistant infections 1. In patients with chronic indwelling catheters, such as this patient, the presence of bacteriuria, including Pseudomonas, often represents colonization rather than infection.
- The patient's age and stage V chronic kidney disease increase the risk of adverse effects from antimicrobial therapy.
- There is no evidence that antimicrobial treatment of bacteriuria in persons with long-term indwelling catheters can reduce the risk of death 1.
- Treatment of asymptomatic bacteriuria in catheterized patients is associated with rapid emergence of antimicrobial resistance in urinary strains 1. If the patient develops symptoms of a urinary tract infection, such as fever, pain, or other signs of infection, treatment with a renally-adjusted dose of an appropriate antibiotic, such as ciprofloxacin or ceftazidime, may be necessary, with susceptibility testing guiding therapy 1.
- The catheter should be changed during treatment if it has been in place for more than 2 weeks.
- Urine cultures should be obtained before starting antibiotics to guide therapy.
- Adequate hydration within the patient's fluid restrictions should be maintained, and the catheter care protocol should be reviewed to prevent future infections.
From the Research
Pseudomonas Infection in Urine with Suprapubic Catheter
- The presence of Pseudomonas in a patient's urine with a suprapubic catheter, particularly in an 88-year-old patient with stage V chronic kidney disease, is a significant concern 2, 3, 4, 5, 6.
- Pseudomonas aeruginosa is a common cause of complicated urinary tract infections, especially in patients with underlying abnormalities and those who have undergone urethral catheterization 2, 3.
- The use of suprapubic catheters, like urethral catheters, can lead to microbial biofilm formation and increase the risk of catheter-associated bacteriuria (CAB) and catheter-associated urinary tract infection (CA-UTI) 4.
Risk Factors and Treatment
- Risk factors for Pseudomonas aeruginosa infection in patients with suprapubic catheters include increasing indwelling time and the absence of antibiotic prophylaxis at the time of catheter placement 4.
- Treatment of Pseudomonas aeruginosa urinary tract infections often involves the use of antimicrobial agents, such as ciprofloxacin, which has been shown to be effective in eradicating the infecting organism 2.
- However, the development of resistance to antimicrobial agents is a concern, and the choice of treatment should be guided by antimicrobial susceptibility testing 2, 3.
Prevention and Management
- Prevention and management of Pseudomonas aeruginosa infections in patients with suprapubic catheters require careful attention to catheter management, including regular replacement and maintenance of a closed drainage system 3, 4.
- Understanding the pathogenesis of Pseudomonas aeruginosa urinary tract infections is crucial for developing effective preventive approaches and novel therapeutic strategies 5, 6.