RT Book, Section A1 Sheehan, Gerard J. A1 de Barra, Eoghan A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107721224 T1 Urinary Tract Infections T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accessmedicine.mhmedical.com/content.aspx?aid=1107721224 RD 2024/03/29 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.