Catheter-Associated Urinary Tract Infections (CAUTI) Treatment Guidelines

Recommended First-Line Treatments for CAUTI

• The European Association of Urology recommends amoxicillin plus an aminoglycoside as a first-line empirical treatment for complicated UTIs, including CAUTI 1
• The European Association of Urology recommends a second-generation cephalosporin plus an aminoglycoside as a first-line empirical treatment for complicated UTIs, including CAUTI 1
• The European Association of Urology strongly recommends an intravenous third-generation cephalosporin as a first-line empirical treatment for complicated UTIs, including CAUTI 2, 3

Rationale Against Using Augmentin as First-Line Therapy

• CAUTIs are frequently caused by organisms with higher resistance rates than uncomplicated UTIs, including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 2, 3
• The microbial spectrum in CAUTIs is broader, requiring more potent antibiotic regimens 2

When Augmentin Might Be Appropriate

• Augmentin could be considered as targeted therapy after culture and susceptibility results confirm susceptibility 2, 3
• The European Association of Urology suggests Augmentin as an option for oral step-down therapy after initial parenteral treatment and clinical improvement 4

Treatment Duration and Catheter Management

• The Infectious Diseases Society of America recommends replacing the catheter if it has been in place for ≥2 weeks to hasten symptom resolution and reduce risk of subsequent infection 5, 6
• The Infectious Diseases Society of America recommends obtaining a urine culture before initiating antimicrobial therapy due to the wide spectrum of potential infecting organisms and increased likelihood of resistance 5, 6
• The Infectious Diseases Society of America recommends treating CAUTI for 7 days if symptoms resolve promptly 4, 5
• The Infectious Diseases Society of America recommends extending treatment to 10-14 days for patients with delayed response 4, 5
• The European Association of Urology recommends considering 14 days of treatment for men when prostatitis cannot be excluded 2

Important Caveats and Pitfalls

• The European Association of Urology and the Infectious Diseases Society of America emphasize that local antimicrobial resistance patterns should guide empirical therapy choices 2, 4
• The European Association of Urology notes that CAUTIs are the leading cause of secondary healthcare-associated bacteremia, with approximately 20% of hospital-acquired bacteremias arising from the urinary tract 1
• The European Association of Urology and the Infectious Diseases Society of America recommend removing catheters as soon as clinically appropriate, as the duration of catheterization is the most important risk factor for CAUTI development 1, 2

Treatment of Catheter-Associated UTI with Morganella morganii and Proteus

Antibiotic Treatment Options

• Ampicillin/sulbactam is a potential option for treating catheter-associated UTI caused by Morganella morganii and Proteus, based on susceptibility results (MIC ≤4/2), for a patient with multiple comorbidities, including diabetes, and may require a 10-14 day course to ensure complete resolution 7

Treatment Duration and Follow-up

• A 10-14 day course of antibiotic treatment may be more appropriate for an elderly patient with multiple comorbidities, including diabetes, to ensure complete resolution of catheter-associated UTI 7
• Consider a follow-up urine culture after completion of antibiotic therapy to confirm eradication of infection, as recommended for patients with catheter-associated UTI 7

Catheter Management

• Discontinuation of catheter use alone may result in eradication of candiduria in almost 40% of patients, but is less effective for bacterial UTIs like this case, and catheter replacement or removal may be necessary to hasten symptom resolution and reduce the risk of subsequent infection 8