• Routine use of prophylactic antimicrobials at the time of catheter removal or replacement has not been shown to be beneficial.
• Empirical treatment should be started with broad-spectrum antibiotics according to local susceptibility patterns.

Antimicrobials guidelines for CA-UTI

Category	Treatment	Comments
Asymptomatic CA-ASB	Not recommended	Only recommended in the following circumstances -Before urologic surgery or implantation of prosthesis in the urinary tract -In pregnancy
Symptomatic CA-UTI	Patients with CA-UTI -not severely ill/without upper UTI symptoms Nitrofurantoin 100 mg PO BID Fosfomycin 3 g PO once stat Levofloxacin 750 mg PO daily Ciprofloxacin 500 mg PO BID Amikacin 15 mg/kg single dose	Patients with CA-UTI who are severely ill -Piperacillin/tazobactam 4.5 g IV q6hr -Ertapenem 1 g IV q24hr -Meropenem 1 g IV q8hr* * preferably used in patients with sepsis and septic shock
Candiduria – Indication Symptomatic Neutropenia (rule out candidemia) urological surgery	Flucanazole- Susceptible strains Flucytosine – Candida glabrata and Candida krusei	-Isolation of Candida in urine usually suggest a colonization -Always rule out obstructive uropathy with imaging if symptomatic candidal urinary infection is suspected
Post-op infections following solid organ transplant with CA-UTI (kidney, liver, heart, lung)	Piperacillin-tazobactam 4.5 g IV q6h or cefoperazone-sulbactam 3 g IVq12h Imipenem- cilastatin 1g IV q8h or Ertapenam 1 g IV q24hr /Meropenem 1g IV q8h	-Obtain blood and urine cultures before starting antibiotics -De-escalate to narrow spectrum agent on receipt of sensitivities

Targeted therapy should be initiated according to urine culture result and tailored according to the susceptibility report. For multidrug resistant organisms, colistin may be necessary; its empiric use is preferably avoided.