Does a Urinary Tract Infection (UTI) with Hafnia alvei require treatment?

From the Guidelines

Yes, a urinary tract infection (UTI) caused by Hafnia alvei requires antibiotic treatment. The management of such infections should be guided by the principles outlined for complicated urinary tract infections (cUTIs), as the microbial spectrum in these cases is broader and antimicrobial resistance is more likely 1. Given that Hafnia alvei is not explicitly listed among the common pathogens in the provided guidelines, its treatment would still follow the general approach for cUTIs, considering factors such as the severity of illness, local resistance patterns, and specific host factors like allergies.

Key considerations in the treatment of UTIs caused by Hafnia alvei include:

• Performing urine culture and susceptibility testing to guide the choice of antimicrobial agent.
• Initial empiric therapy should be based on local resistance patterns and patient factors, with adjustment according to susceptibility testing results.
• The duration of treatment can vary but is generally recommended for 7 to 14 days, depending on the severity of the infection and the patient's response to treatment 1.
• It's crucial to complete the full course of antibiotics as prescribed, even if symptoms improve quickly, to ensure eradication of the infection.

Given the potential for Hafnia alvei to exhibit resistance to various antibiotics, treatment should be tailored based on antimicrobial susceptibility testing. While awaiting these results, empiric therapy may be initiated with broad-spectrum antibiotics, considering the potential for resistance and the severity of the infection. The choice of antibiotic, such as fluoroquinolones or third-generation cephalosporins, should be guided by local resistance patterns and patient-specific factors, including any history of allergies or previous antibiotic use 1.

From the Research

UTI with Hafnia alvei Treatment

• UTIs caused by Hafnia alvei are a rare but potentially severe infection, particularly in patients with underlying medical conditions or compromised immune systems 2, 3.
• The treatment of Hafnia alvei-induced UTIs typically involves the use of antibiotics, with the choice of antibiotic depending on the susceptibility of the bacteria 2, 3, 4.
• Cefepime has been shown to be effective in treating Hafnia alvei infections, including UTIs 2, 3.
• Other antibiotics that may be effective against Hafnia alvei include amoxicillin/clavulanic acid, first-generation cephalosporins, aminoglycosides, imipenem, cotrimoxazole, ciprofloxacin, piperacillin, and cefotaxime 4.
• However, Hafnia alvei can produce inducible Bush group 1 beta-lactamase, which can confer resistance to certain beta-lactam antibiotics, including cefuroxime, ceftriaxone, and ceftazidime 3.
• The use of a urinary tract infection treatment protocol can help improve prescribing practices and reduce the use of inappropriate antimicrobials 5.

Antibiotic Resistance

• Hafnia alvei can exhibit resistance to certain antibiotics, including beta-lactam antibiotics, making treatment challenging 3.
• The use of antibiotics such as cefepime, which has been shown to be effective against Hafnia alvei, can help overcome resistance issues 2, 3.
• It is essential to use antibiotics wisely and follow treatment guidelines to minimize the development of antibiotic resistance 6.

Treatment Guidelines

• The treatment of UTIs, including those caused by Hafnia alvei, should be guided by local susceptibility patterns and treatment guidelines 6.
• A 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam are recommended as first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 6.
• Second-line options include oral cephalosporins, fluoroquinolones, and beta-lactams, such as amoxicillin-clavulanate 6.