Abstract
Guidelines for the treatment of nosocomial urinary tract infections (NUTI) have to take into account: i) the high prevalence of catheter-associated bacteriuria; ii) the lack of important clinical studies; iii) a variable bacterial count (between 10 3 and 10 5 mL –1) considered as significant by authors. NUTI without catheterization are clinically similar to UTI in outpatients, but more frequently due to multi-resistant bacteria. Among catheterized patients, the incidence of dysuria, pain, and urgency is not different between patients who develop bacteriuria and those who do not. However, fever has a high positive diagnostic value. Systematic treatment of NUTI is not recommended despite the morbidity because it reduces neither the incidence of febrile episodes, nor the rate of complications. Moreover, it promotes the selection of resistant bacteria. Exceptions to these recommendations are: treatment of asymptomatic NUTI in patients at high risk of severe complications (neutropenic patients, pregnant women, immunosuppressed patients, patients with diabetes mellitus), as part of a plan to control a cluster of multiresistant infections, before surgery (implantation of a prosthesis, urinary tract procedures), or persistent bacteriuria after catheter removal. All febrile NUTI should be treated given their specific morbidity and mortality. Empirical treatment depends on the local prevalence of resistant bacteria. In febrile NUTI, a 7 to 10 day antibiotic treatment is recommended, combined with the removal or the replacement of the catheter (immediately or after 48h of treatment). A longer treatment is necessary for complicated pyelonephritis or bacteremia, according to bacteria dissemination and urinary tract impairment.
Published Version
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