SEP 2.02 Sepsis - suspected focus in the urogenital tract

Recommendations

≥ 18 years
	Dosage	Remarks
	cefuroxime IV 1500 mg 3 times daily + amikacin IV 20 mg/kg single dose	For sepsis (qSOFA ≥ 2)
	ceftriaxone IV 2000 mg once daily	For sepsis (qSOFA ≥ 2) and pregnancy
	cefuroxime IV 1500 mg 3 times daily	If no sepsis (qSOFA < 2)
	cefuroxime IV 1500 mg 3 times daily + amikacin IV 20 mg/kg single dose	If no sepsis (qSOFA < 2) but known resistance (< 1 year)

Comments

Always obtain urine and blood cultures.

Review urine cultures from the past year to assess whether empirical therapy should be adjusted accordingly. For example, in the case of an ESBL.

Adjust antibiotics according to culture results where possible.

For transurethral, suprapubic or nephrostomy catheter: replace the catheter during treatment if possible, and in the case of a nephrostomy or JJ catheter always consult the urologist.

If there are contraindications to amikacin, consult a microbiologist or infectious diseases physician.
Contraindications to amikacin:

eGFR <30 ml/min/1,73 m2 (CKD-EPI)
Acute deterioration of renal function (defined as a serum creatinine that is twice as high as the pre-existing serum creatinine)
Bilirubin > 100 μmol/l
Kidney transplantation
Tubulotoxic co-medication
Neuromuscular disorders (myasthenia gravis, Lambert-Eaton syndrome)
Pregnancy

Use with caution if eGFR 30-45 ml/min/1.73 m2 (CKD-EPI)

There are circumstances where the estimated renal function differs from the actual renal function, for example with low muscle mass or in acutely worsening renal function. Avoid amikacin if this applies.

In case of (suspected) allergy to penicillins and/or cephalosporins:

See Policy for antibiotic allergy | Radboud UMC

Consult the clinical microbiologist/infectious diseases physician for an alternative regimen.

SEP 2.02 Sepsis - suspected focus in the urogenital tract

≥ 18 years