Controlling Antimicrobial Use Through Reducing Unnecessary Treatment of Catheter Associated Urinary Tract Infections

Controlling Antimicrobial Use Through Reducing Unnecessary Treatment of Catheter Associated Urinary Tract Infections (CARCUTI)

Hypothesis: A short course (3-5 days) of antibiotic therapy (experimental arm) is as safe and effective as a long course of antibiotic therapy for the treatment of catheter-associated urinary tract infections.

Inclusion Criteria:

1. Inpatients ≥ 21 years old.
2. Presence of indwelling urinary catheter at the time of urine culture for ≥2days.
3. Fever >38°C.
4. A urine specimen sent to the hospital microbiological laboratory for culture.
5. An antibiotic order for presumed symptomatic catheter associated urinary tract infection.

Exclusion Criteria:

1. Persistent fever >38°C for more than 24 hours, or any fever >38.9°C.

2. Haemodynamic instability, defined as:

   • Requirement for intravenous vasopressor agents
   • Systolic blood pressure <90 mmHg
   • Acute hypotensive event with drop in systolic blood pressure of >30 mmHg or diastolic blood pressure of >20 mmHg

3. The following laboratory values within the previous 48 hours (if available):

   • White blood cell count>15 or <4 x10^9/L.
   • Procalcitonin>0.25ug/mL
   • C Reactive Protein >100mg/mL
   • An increase in the serum creatinine of more than 50% from baseline

4. New requirement for oxygen supplement.

5. Current admission to a high dependency unit or ICU.

6. Radiological evidence of an upper urinary tract infection

7. Flank pain or tenderness, suggesting an upper urinary tract infection

8. Urologic surgical procedure within the previous 72 hours

9. Known structural genitourinary abnormalities including:

   • Nephrostomy tubes
   • Tumours of the urinary tract
   • Ureteric stenting
   • Ureteric strictures
   • Urolithiasis

10. Bloodstream or other significant infection suspected at any site other than the catheterized urinary tract.

11. Received antibiotics for more than 48 hours prior to randomization.

12. Positive urinary culture with organism resistant to all the investigational antibiotics in the week prior to randomisation.

13. Hypersensitivity to ciprofloxacin, cotrimoxazole and amoxicillin-clavulanate.

14. Pregnancy.