Infectious Diseases in Critical Care Medicine

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Table 7 Nosocomial Urosepsis: Therapeutic Approach

Urosepsis-
associated syndrome Usual uropathogens Urine Gram stain Empiric coverage

. Post-urologic
instrumentation/
procedure

P. aeruginosa GNBs Meropenem

Enterobacterspecies

Serratiaspecies

Amikacin

Third-generation

cephalosporin

Cefepime

Aztreonam

MDR GNBs (suspected

from recent cultures)

GNBs Colistin or polymyxin B

Tigecycline

MDRP. aeruginosa Sulbactam/ampicillin

MDRK. pneumoniae

MDRAcinetobactersp.

. Acute pyelonephritis Group D enterococci Gram-positive cocci
in pairs/chains
E. faecalis(VSE) Piperacillin/tazobactam
Meropenem
E. faecium(VRE) Linezolid
Q/D
. CAB in normal hosts
(CAB/UTI)
. CAB (compromised
hosts)a

Group B streptococci

GNBs

GPCs

Gram-positive cocci

in pairs/chains

No antibiotic therapy

Group D streptococci

E. faecalis(VSE) Piperacillin/tazobactam

Meropenem

E. faecium(VRE) Linezolid

Q/D

. CAB (compromised
hosts)

Coliforms

MDR GNBs

GNBs

GNBs

Piperacillin/tazobactam

Meropenem

Fosfomycin

aOnly in abnormal hosts with unilateral/bilateral urinary tract obstruction, preexisting renal disease, or non-

leukopenic compromised hosts (DM, SLE, cirrhosis, multiple myeloma, on steroids).
Abbreviations: CAB, Catheter-associated bacteriuria; GNB, gram-negative bacilli; CPC, gram-positive cocci in
pairs/chain; MDR, multidrug resistant; VRE, vancomycin-resistant enterococci; VSE, vancomycin-susceptible
enterococci.

Urosepsis in Critical Care 293