Spectrum: Local Antimicrobial Stewardship, for Eastern Health

UTI - ICU

Notes

Collect urine and blood cultures BEFORE ABx

Consideration must be given to an obstructed urinary tract or a complication of UTI (i.e. renal abscess, emphysematous pyelonephritis) and imaging is advised.

Obstructed pyelonephritis is a urologic emergency.

Change the catheter if present >2wks, and remove if not indicated.

Suggested Regimen

The choice between the following agents should be made based on the acuity of illness, previous culture data from the same patient, and risk factors for drug resistant organisms.

Ceftriaxone 2g IV daily

AND

Gentamicin 5 to 7 mg/kg IV daily

may need to calculate adjusted body weight if patient obese, see drug monograph

OR

Piperacillin-Tazobactam 3.375g IV q6h

OR

Meropenem 500mg IV q6h when known to be colonized with ESBL, and consider when multiple risk factors are present

ESBL RFs

Healthcare: prolonged hospitalization, ICU stay, percutaneous feeding tubes, nursing home residence, urinary catheterization

Penicillin Anaphylaxis

Ciprofloxacin 400mg IV q12h

AND

Gentamicin 5 to 7 mg/kg IV daily

may need to calculate adjusted body weight if patient obese, see drug monograph

Directed Therapy

Day 3 bundle