Intravesical therapies offer targeted strategy for catheter-associated UTIs, combating antimicrobial resistance.

Catheter-associated urinary tract infections (CAUTIs) are a leading cause of healthcare-associated infections, significantly increasing patient morbidity, mortality, and healthcare costs. Systemic antibiotics, the current standard, frequently fail due to poor penetration into bacterial biofilms, localized infection sites, and the rapid rise of multidrug-resistant (MDR) pathogens. This creates an urgent need for alternative, targeted therapeutic strategies that can overcome these limitations and reduce antibiotic overuse.

This review systematically examined current and emerging intravesical therapies for CAUTIs, focusing on their roles in both treatment and prevention. It explored CAUTI pathogenesis, the mechanisms of biofilm development, and existing clinical approaches including antimicrobial stewardship and catheter management. The authors reviewed evidence for direct instillation of various antimicrobial agents into the bladder, encompassing both traditional antibiotics and novel non-antibiotic alternatives.

Intravesical therapy, by directly delivering agents to the bladder, offers a promising approach to improve CAUTI management and reduce antimicrobial resistance (AMR). The review highlighted evidence for intravesical antibiotics such as gentamicin, amikacin, colistin, fosfomycin, and trimethoprim, noting their application in other urological disorders.

Non-antibiotic alternatives, including antiseptic solutions, bacteriophages, antimicrobial peptides, natural bioactives, probiotics, and silver nanoparticles, were also discussed for their potential synergistic use with antibiotics to reduce resistance emergence. These local therapies can effectively target biofilm-forming bacteria that colonize catheters, a key factor in persistent infection and treatment failure, thereby bypassing systemic exposure and its associated resistance pressures.