How is urosepsis treated?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The primary uropathogens include gram-negative aerobic bacilli, such as coliforms or enterococci. Pseudomonas aeruginosa, Enterobacter species, and Serratia species are rare uropathogens and are associated with urologic instrumentation.

Monotherapy for urosepsis due to aerobic gram-negative bacilli may include aztreonam, levofloxacin, a third- or fourth-generation cephalosporin, or an aminoglycoside. However, preferred monotherapy for enterococcal urosepsis involves ampicillin or vancomycin. For VRE urosepsis, linezolid or daptomycin may be used.

Empiric therapy for community-acquired urosepsis consists of levofloxacin, aztreonam, or an aminoglycoside plus ampicillin. For nosocomial urosepsis, a fourth-generation cephalosporin, piperacillin-tazobactam, imipenem, or meropenem, with or without an aminoglycoside, is preferred.


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