From the Guidelines
Treatment for Urosepsis with Pseudomonas and Proteus Species Treatment for urosepsis with Pseudomonas and Proteus species typically involves a combination of broad-spectrum antibiotics, such as piperacillin-tazobactam (3.375g IV every 6 hours) or ceftazidime (2g IV every 8 hours), in conjunction with an aminoglycoside, such as gentamicin (5-7 mg/kg IV daily) 1.
- The choice of empiric antibiotic therapy should be based on local epidemiology, individual patient risk factors for difficult-to-treat pathogens, clinical severity of infection, and infection source 1.
- The duration of therapy is typically 10-14 days, with the possibility of extension based on clinical response and microbiological clearance 1.
- Additionally, supportive care, including fluid resuscitation and hemodynamic monitoring, is crucial in managing sepsis 1.
- It is also important to note that the use of carbapenems should be limited to preserve the activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
- Newer antibiotics such as ceftolozane/tazobactam and ceftazidime/avibactam have been approved for the treatment of complicated intra-abdominal infections, including infections caused by ESBL-producing Enterobacteriaceae and P. aeruginosa 1.
- The treatment should be tailored to local policies and resistance patterns, and the choice between different agents should be based on local resistance patterns and optimized 1.
From the FDA Drug Label
Gentamicin Sulfate 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) The combined effect of gentamicin and carbenicillin is synergistic for many strains of Pseudomonas aeruginosa In serious infections when the causative organisms are unknown, gentamicin sulfate may be administered as initial therapy in conjunction with a penicillin-type or cephalosporin-type drug before obtaining results of susceptibility testing
The treatment for urosepsis caused by Pseudomonas and Proteus species is gentamicin in combination with another antibiotic, such as carbenicillin or a penicillin-type or cephalosporin-type drug 2 2.
- Gentamicin is effective against Pseudomonas aeruginosa and Proteus species
- Combination therapy with gentamicin and another antibiotic may be synergistic for some strains of Pseudomonas aeruginosa
- Gentamicin may be used as initial therapy in suspected or confirmed gram-negative infections, including urosepsis, until susceptibility testing results are available 2.
From the Research
Treatment for Urosepsis Caused by Pseudomonas and Proteus Species
The treatment for urosepsis caused by Pseudomonas and Proteus species involves several strategies, including:
- Supportive therapy to stabilize and maintain blood pressure 3
- Antimicrobial therapy, which should be initiated early and ideally within the first hour of diagnosis 4, 5
- Control or elimination of the complicating factor, such as urinary tract obstruction or abscess formation 3, 4
- Specific sepsis therapy, which may include the use of broad-spectrum beta-lactam antibiotics, such as piperacillin/tazobactam, carbapenems, or cephalosporin/beta-lactamase inhibitor combinations 4, 6
Antimicrobial Therapy
The choice of antimicrobial therapy should be guided by local pathogen patterns of resistance and the patient's risk factors for resistant organisms 3, 4, 6. For Pseudomonas aeruginosa infections, novel fluoroquinolones, new combinations of β-lactams/β-lactamase inhibitors, and cefiderocol, a new cephalosporin, show promising results 7. Extended-infusion of β-lactams and bacteriophage therapy may also be beneficial 7.
Key Considerations
When selecting antimicrobial therapy, it is essential to consider the following factors: