TY  - CHAP
M1  - Book, Section
TI  - Urinary Tract Infections
A1  - Sheehan, Gerard J.
A1  - de Barra, Eoghan
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
PY  - 2015
T2  - Principles of Critical Care, 4e
AB  - Empiric  antimicrobial  therapy  for  acute  severe  urosepsis  should  initially  include  two  agents  with  activity  against  gram-negative  bacilli,  such  as  a  third-  or  fourth-generation  cephalosporin,  aztreonam,  or  extended-spectrum  penicillin  in  combination  with  either  a  fluoroquinolone  or  an  aminoglycoside.Where  local  epidemiology  indicates  significant  prevalence  of  extended-spectrum  ß-lactamases  among  Enterobacteriaceae,  then  a  carbapenem  such  as  imipenem,  meropenem,  ertapenem,  or  doripenem  is  preferred  while  awaiting  definitive  cultures.Where  local  epidemiology  indicates  significant  prevalence  of  carbapenem-resistant  Enterobacteriaceae,  then  colistin  and  a  carbapenem  should  be  chosen  while  awaiting  definitive  cultures.Urine  and  blood  cultures  should  be  obtained  prior  to  the  first  antimicrobial  doses,  which  should  be  given  without  delay.Once  the  pathogen  is  identified  by  a  positive  urine  or  blood  culture,  the  antimicrobial  regimen  should  be  tailored  to  a  single,  least  toxic  agent  with  the  narrowest  spectrum,  based  on  susceptibility  data.Patients  with  severe  urosepsis  requiring  ICU  admission  should  have  imaging  of  the  urinary  tract  on  an  urgent  basis,  preferably  by  computed  tomography  with  intravenous  contrast,  because  suppurative  complications  require  drainage  as  a  priority.Percutaneous  drainage  by  an  interventional  radiologist  is  generally  preferred  to  drain  definitively  or  stabilize  temporarily  a  patient  with  suppurative  complications.Urinary  catheters  cause  a  high  incidence  (3%-7%  per  day)  of  bacteriuria  and  candiduria;  the  latter  associated  with  broad-spectrum  antimicrobial  therapy.Asymptomatic  catheter–associated  bacteriuria  or  candiduria  should  not  be  treated;  the  only  exceptions  are  transplant  and  neutropenic  patients,  and  before  instrumentation  of  the  urinary  tract.The  continued  usefulness  of  a  urinary  catheter  should  be  reassessed  on  a  regular  basis,  and  removal  in  selected  patients  should  be  considered.Fever  or  sepsis  should  only  be  attributed  to  catheter-associated  bacteriuria  and  treated  only  after  exclusion  of  other  potential  causes  of  infection.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1107721224
ER  -