Infectious Diseases I

A urinary culture should be obtained before initiation of antimicrobial therapy.

if still indicated, replaced to hasten resolution of symptoms.

Similar to other health care–acquired infections, empiric antimicrobial therapy should be based on local

pathogen prevalence, pathogen-specific risk factors (e.g., MDRO risk factors), previously identified

pathogens, previous antimicrobial exposure, and local antibiotic susceptibility.

Empiric antimicrobial therapy should be de-escalated according to the identified pathogen(s) and

respective antimicrobial susceptibility on final urine culture results. Empiric antimicrobial therapy

should be discontinued in patients without CAUTI or other sources of infection.

Definitive antimicrobial therapy should be based on final antimicrobial susceptibility results and

presence of concomitant infection(s). Catheter irrigation (i.e., bladder washings) is not recommended.

Shorter duration of antimicrobial therapy should be considered depending on clinical response.

Regardless of catheter removal, duration of antimicrobial therapy should be 7 days for patients with

resolution of signs and symptoms within 72 hours of appropriate antimicrobial therapy and up to 14

days in patients with resolution after 72 hours.

Patients with persistent signs and symptoms of CAUTI should receive a urologic workup to assess for

abscess or other causes of relapse.

Patient Case

Questions 7 and 8 pertain to the following case.

P.H. is a 67-year-old woman admitted from a long-term care facility to the MICU for respiratory failure secondary

to severe pneumonia. P.H. is initiated on vancomycin and levofloxacin and has a urethral catheter placed in the

emergency department. On ICU day 6, P.H. has a new fever with a temperature of 101.9°F (38.9°C) and an

elevated WBC to 18 x 103 cells/mm3, despite an initial clinical response to pneumonia therapy. Blood and urine

cultures are sent. Urinalysis reveals many bacteria and greater than 10 white blood cells/mm3.

Which intervention is most appropriate in P.H.?

P.H.’s fever and leukocytosis resolved in less than 48 hours, and antibiotics were narrowed according to the

final susceptibilities report. Which best depicts how long the ICU team should treat P.H.’s CAUTI?