Refractory XDR Klebsiella pneumoniae CAUTI Treated with non-antibiotic urinary acidification: a 12-month follow-up case report and literature review.

Background The increase of catheter-associated urinary tract infections (CAUTIs) caused by extensively drug-resistant (XDR) Klebsiella pneumoniae represents a critical failure of the current antimicrobial paradigm. In geriatric cohorts with significant comorbidities, the exhaustion of conventional therapeutic options often precipitates a cycle of recurrent sepsis, prolonged hospitalization, and prohibitively high healthcare expenditure. When "last-resort" agents such as ceftazidime-avibactam and colistin fail, clinicians in resource-limited settings are left with no guideline-endorsed alternatives. This report evaluates the clinical and economic impact of a pragmatic non-antibiotic acidification strategy applied as a salvage intervention in a "pan-resistant" scenario.

Case Report We describe the complex clinical course of an 82-year-old female with type 2 diabetes and neurogenic bladder following an acute ischemic stroke. Despite rigorous adherence to standard catheter care protocols, she developed intractable, recurrent XDR K. pneumoniae CAUTI. The pathogen demonstrated resistance to all first-line and reserve antibiotics, leading to four ICU admissions within a single trimester. With methenamine hippurate unavailable and the family declining suprapubic diversion, we initiated a physiological acidification protocol. This regimen synergized high-dose oral ascorbic acid (2g/day) - hypothesized to downregulate virulence genes - with twice-daily bladder irrigation using diluted (0.25%) acetic acid to create a hostile pH environment for bacterial adherence.Literature Search Methods and Results: Utilizing PRISMA principles adapted for narrative synthesis, a systematic search of PubMed and Scopus yielded 145 initial results. After screening for relevance to non-antibiotic salvage therapy and biofilm disruption, 17 highly relevant articles were incorporated to validate the mechanistic plausibility of our combined protocol.

Conclusions Following initiation of the intervention, a sustained absence of symptomatic episodes was observed. Over a 12-month follow-up, the patient remained free of CAUTI, requiring no further antibiotic therapy. We posit that low-cost, accessible acidification adjuncts represent a vital "frugal innovation" for anti-microbial stewardship in vulnerable populations.