Treatment

Choice of therapy for UTIs depends on specific antimicrobial susceptibilities of the bacteria isolated from urine and blood cultures. Fluoroquinolones are widely used in this population; cephalosporins are alternative agents. Anaerobic organisms are rarely involved in these infections and are not routinely covered. For infections caused by coagulase-negative staphylococci or by ampicillin-resistant enterococci, vancomycin is the antimicrobial agent of choice. Length of treatment depends upon the severity of the infection, with two weeks or longer duration of therapy for pyelonephritis. Recurrent infections of the urinary tract prompt further investigation with imaging studies to exclude anatomic abnormalities and obstruction.

Surgical wound infections require appropriate debridement and adjunctive antimicrobial therapy. Empiric coverage is directed at gram-positive cocci and gram-negative bacilli until deep culture data is available to guide antimicrobial therapy.

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