Antimicrobial Strategies for Complicated UTIs: New Agents and Treatment Modifications

Treating complicated urinary tract infections (UTIs) requires consideration of various patient factors. In this second mini podcast episode, Kim Leuthner, PharmD, FIDSA, explains why it is essential to understand the patient's medical history, previous antibiotic use, culture results, and the duration and removability of complications.

Leuthner says pathology knowledge, including the specific organisms and the institutional environment, is crucial. Empirical therapy is selected based on patient history and the risk of drug-resistant pathogens. Therapy is modified for renal impairment by adjusting dosages, maintaining intervals, and optimizing drug exposure.

Common pathogens in long-term care facilities and catheter-related UTIs include E coli, Klebsiella, Pseudomonas, ESBL and AmpC producers, and occasionally Acinetobacter. Source control is ideal, but newer agents are used against multidrug-resistant strains.

UTIs in patients from rehab facilities and nursing homes are managed similarly to standard therapy, with source control if possible, says Leuthner. Extended treatment durations may be necessary, posing a risk of further infections.

Challenges in treating complicated UTIs in nosocomial settings include the length of therapy and the limitations of newer agents for outpatient care. Antimicrobial therapies for gram-negative causes include ertapenem, meropenem, ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, ceftolozane-tazobactam, and cefiderocol. Leuthner concludes that care should be taken regarding drug penetration into the urine when considering treatment options.

This is part 2 of a mini podcast series with Kim Leuthner, PharmD, FIDSA. Click here for part 1, in which Leuthner breaks down what makes a UTI complicated and highlights the patients most at risk.