1
|
Guerriero S, Matteini E, Gross MM, Gavi F, Tamburrini E, Murri R, Torti C, Sacco E. Complicated urinary tract infections: an update of new and developing antibiotics. Expert Opin Pharmacother 2025; 26:167-177. [PMID: 39773267 DOI: 10.1080/14656566.2024.2446632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Complicated urinary tract infections (cUTIs) represent a significant clinical challenge due to their association with sepsis, high morbidity and mortality, and an increased risk of recurrence and chronic infection. Effective management requires prompt, targeted interventions. AREAS COVERED This review highlights the importance of early, targeted antibiotic therapy based on local resistance profiles, patient-specific factors, and pharmacokinetic/pharmacodynamic considerations. We examined emerging and existing antibiotics, including beta-lactams, fluoroquinolones, aminoglycosides, and beta-lactamase inhibitor combinations, which show potential against multidrug-resistant organisms (MDRO) linked to cUTI. Additionally, we propose revisiting the broad definition of cUTI to promote a more pragmatic approach that minimizes unnecessary antibiotic use and hospitalization. EXPERT OPINION Current evidence underscores the need for antimicrobial stewardship, precise diagnostics, and innovative therapies to address cUTI while mitigating antimicrobial resistance. A targeted, patient-centered approach is essential to optimize outcomes and reduce the burden of resistant infections.
Collapse
Affiliation(s)
- Silvia Guerriero
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Matteini
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maya M Gross
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Gavi
- Scuola di Specializzazione in Urologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Urologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Enrica Tamburrini
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Carlo Torti
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Emilio Sacco
- Dipartimento di Urologia, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Nelson Z, Tarik Aslan A, Beahm NP, Blyth M, Cappiello M, Casaus D, Dominguez F, Egbert S, Hanretty A, Khadem T, Olney K, Abdul-Azim A, Aggrey G, Anderson DT, Barosa M, Bosco M, Chahine EB, Chowdhury S, Christensen A, de Lima Corvino D, Fitzpatrick M, Fleece M, Footer B, Fox E, Ghanem B, Hamilton F, Hayes J, Jegorovic B, Jent P, Jimenez-Juarez RN, Joseph A, Kang M, Kludjian G, Kurz S, Lee RA, Lee TC, Li T, Maraolo AE, Maximos M, McDonald EG, Mehta D, Moore JW, Nguyen CT, Papan C, Ravindra A, Spellberg B, Taylor R, Thumann A, Tong SYC, Veve M, Wilson J, Yassin A, Zafonte V, Mena Lora AJ. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2024; 7:e2444495. [PMID: 39495518 DOI: 10.1001/jamanetworkopen.2024.44495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2024] Open
Abstract
Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. Objective To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength. Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches. Findings A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation. Conclusions and Relevance In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
Collapse
Affiliation(s)
- Zachary Nelson
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | - Abdullah Tarik Aslan
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Susan Egbert
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Tina Khadem
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katie Olney
- University of Kentucky Healthcare, Lexington
| | - Ahmed Abdul-Azim
- Rutgers Health Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | - Mariana Barosa
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | | | - Alyssa Christensen
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | | | | | | | | | - Emily Fox
- UT Southwestern MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Boris Jegorovic
- Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorovic", Belgrade, Serbia
| | - Philipp Jent
- Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Annie Joseph
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Minji Kang
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Sarah Kurz
- University of Michigan Medical School, Ann Arbor
| | | | - Todd C Lee
- McGill University, Montreal, Quebec, Canada
| | - Timothy Li
- The Chinese University of Hong Kong, Hong Kong, China
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Italy
| | - Mira Maximos
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | | | - Dhara Mehta
- Bellevue Hospital Center, Manhattan, New York, New York
| | | | | | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | | | - Brad Spellberg
- Los Angeles General Medical Center, Los Angeles, California
| | - Robert Taylor
- Newfoundland and Labrador Health Services, St John's, Newfoundland & Labrador, Canada
- Memorial University, St. John's, Newfoundland & Labrador, Canada
| | | | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michael Veve
- Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - James Wilson
- Rush University Medical Center, Chicago, Illinois
| | - Arsheena Yassin
- Rutgers Health Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | | |
Collapse
|
3
|
Tverring J, Månsson E, Andrews V, Ljungquist O. Pivmecillinam with Amoxicillin/Clavulanic acid as step down oral therapy in febrile Urinary Tract Infections caused by ESBL-producing Enterobacterales (PACUTI). Trials 2023; 24:568. [PMID: 37660037 PMCID: PMC10474767 DOI: 10.1186/s13063-023-07542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/25/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Oral treatment alternatives for febrile urinary tract infections are limited in the era of increasing antimicrobial resistance. We aim to evaluate if the combination of pivmecillinam and amoxicillin/clavulanic acid is non-inferior to current alternatives for step-down therapy in adult patients with febrile urinary tract infection. METHODS We plan to perform an investigator-initiated non-inferiority trial. Adult hospitalised patients treated with 1-5 days of intravenous antibiotics for acute febrile urinary tract infection caused by extended spectrum beta-lactamase (ESBL) producing Enterobacterales will be randomised 1:1 to either control (7-10 days of either oral ciprofloxacin 500 mg twice daily or oral trimethoprim-sulfamethoxazole 800 mg/160 mg twice daily or intravenous ertapenem 1 g once daily, depending on sex, drug allergy, glomerular filtration rate and susceptibility testing) or intervention (10 days of pivmecillinam 400 mg three times daily and amoxicillin/clavulanic acid 500/125 mg three times daily). The primary outcome will be clinical cure 10 days (+/- 2 days) after antibiotic treatment completion. Clinical cure is defined as being alive with absence of fever and return to non-infected baseline of urinary tract symptoms without additional antibiotic treatment or re-hospitalisation (for urinary tract infection) based on a centralised allocation-blinded structured telephone interview. We plan to recruit 330 patients to achieve 90% power based on a sample size simulation analysis using a two-group comparison, one-sided alpha of 2.5%, an absolute non-inferiority margin of 10% and expecting 93% clinical cure rate and 10% loss to follow-up. The primary endpoint will be analysed using generalised estimated equations and reported as risk difference for both intention-to-treat and per protocol populations. Patients are planned to be recruited from at least 10 centres in Sweden from 2023 to 2026. DISCUSSION If the combination of pivmecillinam and amoxicillin/clavulanic acid is found to be non-inferior to the control drugs there are potential benefits in terms of tolerability, frequency of interactions, outpatient treatment, side effects, nosocomial infections and drive for further antimicrobial resistance compared to existing drugs. TRIAL REGISTRATION NCT05224401. Registered on February 4, 2022.
Collapse
Affiliation(s)
- Jonas Tverring
- Department of Clinical Sciences Helsingborg (AKVH), Faculty of Medicine, Lund University, Lund, Sweden.
- Department of Infectious Diseases, Helsingborg Hospital, Region Skåne, Helsingborg, Sweden.
| | - Emeli Månsson
- Department of Infectious Diseases and Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Vigith Andrews
- Department of Clinical Microbiology, Lund University Hospital, Lund, Sweden
| | - Oskar Ljungquist
- Department of Clinical Sciences Helsingborg (AKVH), Faculty of Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Helsingborg Hospital, Region Skåne, Helsingborg, Sweden
| |
Collapse
|
4
|
Zimmerman DE, Tomas M, Miller D, Tomcsanyi L, Signorella C, Montepara CA, Covvey JR, Guarascio AJ. Cephalosporins for the treatment of uncomplicated pyelonephritis: A systematic review. J Am Pharm Assoc (2003) 2023; 63:1461-1471. [PMID: 37414282 DOI: 10.1016/j.japh.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The 2011 Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases guidelines recommend ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP) as first-line agents to treat uncomplicated acute pyelonephritis (APN). OBJECTIVE With increasing antimicrobial resistance rates and recent changes in practice patterns, the objective of this systematic review was to describe the effectiveness of cephalosporins for uncomplicated APN in more recently published literature. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. We searched PubMed, Embase, and Scopus for publications between January 2010 and September 2022. Eligible articles detailed patients with uncomplicated APN, treated with first- to fourth-generation cephalosporins, and identified a clinical, microbiological, or health care utilization outcome. Studies with more than 30% of complicated APN patients, non-English-language studies, case reports, case series, pharmacodynamic or pharmacokinetic studies, and in vitro laboratory or animal studies were excluded. Screening, review, and extraction were performed independently by 2 researchers, plus a third for conflict resolution. Critical appraisal of studies was performed using Joanna Briggs Institute checklists. RESULTS Eight studies met inclusion, including 5 cohort studies (62.5%), 2 randomized controlled trials (25%), and 1 nonrandomized experimental study (12.5%). Cephalosporins most used across the studies included cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone. Outcomes assessed were diverse, including clinical or microbiological success and time to defervescence or symptom resolution. Cephalosporins displayed effectiveness for the treatment of acute uncomplicated APN regardless of study design or the presence of a comparison group. No trials reported inferiority of clinical treatment outcomes compared with a fluoroquinolone or SMX-TMP. CONCLUSION Cephalosporins may be viable treatment options for the management of uncomplicated APN.
Collapse
|
5
|
Ezure Y, Rico V, Paterson DL, Hall L, Harris PNA, Soriano A, Roberts JA, Bassetti M, Roberts MJ, Righi E, Wright H. Efficacy and Safety of Carbapenems vs New Antibiotics for Treatment of Adult Patients With Complicated Urinary Tract Infections: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofaa480. [PMID: 35474756 PMCID: PMC9031024 DOI: 10.1093/ofid/ofaa480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs), with the comparators being new antibiotics evaluated for this indication. We searched 13 electronic databases for published randomized controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed using the Population, Intervention, Comparison, Outcomes, and Study framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favored the new antibiotic groups, although this was not statistically significant (risk ratio [RR], 0.91; 95% CI, 0.79–1.04). A pooled estimate examining clinical response alone showed no difference between treatment arms (RR, 1.00; 95% CI, 0.96–1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR, 0.85; 95% CI, 0.79–0.91). New antibiotic treatments demonstrated a superior microbiological response compared with carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from those of carbapenems.
Collapse
Affiliation(s)
- Yukiko Ezure
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Veronica Rico
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Lisa Hall
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jason A Roberts
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology, Critical Care Emergency, and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Hospital Policlinico San Martino—IRCCS, Genoa, Italy
| | - Matthew J Roberts
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Elda Righi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Hugh Wright
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| |
Collapse
|
6
|
Suliman ENAEE, Thomas D, Elnour AA, Robin N, Maas M. Systematic review on the choice of antibiotics for management of complicated urinary tract bacterial infections and acute pyelonephritis. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00858-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Gatti M, Viaggi B, Rossolini GM, Pea F, Viale P. An Evidence-Based Multidisciplinary Approach Focused at Creating Algorithms for Targeted Therapy of BSIs, cUTIs, and cIAIs Caused by Enterobacterales in Critically Ill Adult Patients. Infect Drug Resist 2021; 14:2461-2498. [PMID: 34234476 PMCID: PMC8256626 DOI: 10.2147/idr.s314241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023] Open
Abstract
Prompt implementation of appropriate targeted antibiotic therapy represents a valuable approach in improving clinical and ecological outcome in critically septic patients. This multidisciplinary opinion article focused at developing evidence-based algorithms for targeted antibiotic therapy of bloodstream (BSIs), complicated urinary tract (cUTIs), and complicated intrabdominal infections (cIAIs) caused by Enterobacterales. The aim was to provide a guidance for intensive care physicians either in appropriately placing novel antibiotics or in considering strategies for sparing the broadest-spectrum antibiotics. A multidisciplinary team of experts (one intensive care physician, one infectious disease consultant, one clinical microbiologist and one MD clinical pharmacologist), performed several rounds of assessment to reach agreement in developing six different algorithms according to the susceptibility pattern (one each for multi-susceptible, extended-spectrum beta-lactamase-producing, AmpC beta-lactamase-producing, Klebsiella pneumoniae carbapenemase (KPC)-producing, OXA-48-producing, and Metallo-beta-lactamase (MBL)-producing Enterobacterales). Whenever multiple therapeutic options were feasible, a hierarchical scale was established. Recommendations on antibiotic dosing optimization were also provided. In order to retrieve evidence-based support for the therapeutic choices proposed in the algorithms, a comprehensive literature search was performed by a researcher on PubMed-MEDLINE from inception until March 2021. Quality and strength of evidence was established according to a hierarchical scale of the study design. Only articles published in English were included. It is expected that these algorithms, by allowing prompt revision of antibiotic regimens whenever feasible, appropriate place in therapy of novel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and pharmacokinetic/pharmacodynamic optimization of antibiotic dosing regimens, may be helpful either in improving clinical outcome or in containing the spread of antimicrobial resistance.
Collapse
Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero Universitaria Sant'Orsola, Bologna, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi, University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero Universitaria Sant'Orsola, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Sant'Orsola, Bologna, Italy
| |
Collapse
|
8
|
Han R, Teng M, Zhang Y, Zhang T, Wang T, Chen J, Li S, Yang B, Shi Y, Dong Y, Wang Y. Choosing Optimal Antibiotics for the Treatment of Patients Infected With Enterobacteriaceae: A Network Meta-analysis and Cost-Effectiveness Analysis. Front Pharmacol 2021; 12:656790. [PMID: 34220501 PMCID: PMC8245689 DOI: 10.3389/fphar.2021.656790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Overuse of carbapenems has led to the increasing carbapenem-resistant Enterobacteriaceae. It is still unknown whether other antibiotics [especially novel β-lactam/β-lactamase inhibitor combinations (BL/BLIs)] are better than carbapenems in the treatment of Enterobacteriaceae. A systematic literature search was performed to identify randomized controlled trials (RCTs) assessing the efficacy and safety of any antibiotics on Enterobacteriaceae infections. We carried out a traditional paired meta-analysis to compare ceftazidime/avibactam to comparators. Network meta-analysis (NMA) was conducted to integrate direct and indirect evidence of all interventions. Moreover, cost-effectiveness analysis using a combined decision analytical Markov model was completed for the treatment of patients with complex urinary tract infection (cUTI). A total of 25 relevant RCTs were identified, comprising 15 different interventions. Ceftazidime/avibactam exhibited comparable efficacy and safety with comparators (carbapenems) in the paired meta-analysis. In the NMA, the surface under the cumulative ranking curve probabilities showed that in terms of efficacy, the interventions with the highest-ranking were meropenem/vaborbactam, meropenem, imipenem/cilastatin, ceftriaxone, ceftazidime/avibactam, and ceftolozane/tazobactam [but no significant difference between any two antibiotics (p > 0.05)]. Regarding safety, ceftazidime/avibactam had a higher incidence of adverse events than that of piperacillin/tazobactam (relative risk = 0.74, 95% confidence interval = 0.59–0.94). Based on drug and hospitalization costs in China, the incremental cost-effectiveness ratio per quality-adjusted life-year gained in the patients with cUTI for meropenem, ceftazidime/avibactam, and ceftolozane/tazobactam compared to imipenem/cilastatin were US$579, US$24569, and US$29040, respectively. The role of these BL/BLIs to serve as alternatives to carbapenems requires large-scale and high-quality studies to validate.
Collapse
Affiliation(s)
- Ruiying Han
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengmeng Teng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Tao Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Taotao Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Jiaojiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sihan Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yaling Shi
- Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
9
|
Tehrani S, Elyasi F, Abolghasemi S. Levofloxacin versus ceftriaxone for treatment of acute pyelonephritis in Iranian adults. Infect Disord Drug Targets 2020; 21:603-607. [PMID: 32720608 DOI: 10.2174/1871526520999200727154214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Acute pyelonephritis is among the most common bacterial infections. Options for initial treatment of pyelonephritis include an extended-spectrum cephalosporin or a fluoroquinolone. In this study, we aimed to compare the clinical outcomes of patients receiving ceftriaxone to those who received levofloxacin for the treatment of acute pyelone-phritis. METHODS In this randomized, open-label trial, hospitalized adults with acute pyelonephritis were treated with ceftriaxone (1g IV every 12 hours) or levofloxacin (750 mg IV daily) for at least 7 days. Clinical and microbiological characteristics were compared among patients treated with ceftriaxone and levofloxacin. RESULTS A total of 59 patients were randomized, 30 to the ceftriaxone group and 29 to the levofloxacin group. The clinical response for 68.0% of patients in the ceftriaxone group and 56.0% of patients in the levofloxacin group were cured. The mi-crobiological response (pathogen eradication rates) was 68.7% in the ceftriaxone group and 21.4% in the levofloxacin group.(P value=0.00028) Escherichia coliwas the most common pathogen (n = 31), followed by Klebsiella pneumoniae(n = 21). High resistance rates were detected for cotrimoxazole (55%), ciprofloxacin (48%), and ceftriaxone (34.4%) in isolat-ed E.coli. Likewise, all K. pneumoniaeisolates were resistant to ciprofloxacin. CONCLUSIONS Our study indicates that ceftriaxone was more effective than levofloxacin in the treatment of acute pyelone-phritis, on the basis of microbiological response, but there were no statistically significant differences between the treatment groups in the rates of clinical cure.The resistance of uropathogens to the most used antibiotics was relatively high. Choosing the treatment regimen based on susceptibility testing results and shortening the duration of the therapy are now recommend-ed to be the most important approaches to decrease the spread of antibiotic resistance worldwide.
Collapse
Affiliation(s)
- Shabnam Tehrani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Fereshteh Elyasi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Sara Abolghasemi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| |
Collapse
|
10
|
Tan X, Pan Q, Mo C, Li X, Liang X, Li Y, Lan Y, Chen L. Carbapenems vs alternative antibiotics for the treatment of complicated urinary tract infection: A systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e18769. [PMID: 31914101 PMCID: PMC6959894 DOI: 10.1097/md.0000000000018769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Complicated urinary tract infections (cUTI) are universal reasons for hospitalization, and highly likely to develop into sepsis or septic shock. Carbapenem antibiotics with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing different carbapenem antibiotics for cUTI. Network meta-analysis is a useful tool to compare multiple treatments when there is limited or no direct evidence available. OBJECTIVE The aim of this study is to compare the efficacy and safety of different carbapenems with alternative antibiotics for the treatment of cUTI. METHODS Pubmed, Medline, CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients receiving carbapenem were included. We performed network meta-analysis to estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and indirect evidence; traditional meta-analysis was also performed. Primary outcomes were clinical and microbiological treatment success. RESULTS A total of 19 studies and 7380 patients were included in the analysis. Doripenem (DOPM) was associated with lower clinical treatment success rates than other carbapenems. Although the efficacy of other carbapenems by RRs with 95% CrIs did not show statistical differences, the cumulative rank probability indicated that meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher clinical and microbiological treatment success rates; imipenem/cilastatin (IC) and MV showed higher risk of adverse events (AEs). CONCLUSIONS MV was associated with higher treatment success rates for cUTI, especially for cUTI caused by carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.
Collapse
Affiliation(s)
| | | | | | - Xianshu Li
- Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China
| | - Xueyan Liang
- Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China
| | - Yan Li
- Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China
| | | | - Lingyuan Chen
- Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China
| |
Collapse
|
11
|
Ramasubramanian V, Murlidharan P, Nambi S, Pavithra S, Puthran S, Petigara T. Efficacy and Cost Comparison of Ertapenem as Outpatient Parenteral Antimicrobial Therapy in Acute Pyelonephritis due to Extended-spectrum Beta-lactamase-producing Enterobacteriaceae. Indian J Nephrol 2018; 28:351-357. [PMID: 30270995 PMCID: PMC6146727 DOI: 10.4103/ijn.ijn_207_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) programs are becoming an increasingly popular trend in clinical practice as they offer several benefits to both patients and health-care setups. While OPAT is an established clinical practice in the Western world, the concept itself is alien to patients in India as they prefer the security of hospitals to receive antibiotics over OPAT. We evaluated the clinical response and cost comparison of ertapenem under OPAT versus inpatient settings in patients with extended-spectrum beta-lactamase (ESBL)-positive acute pyelonephritis (APN) given the increasing importance of optimizing both hospital beds and overall cost of patient care in India. APN was chosen as the indication to be studied as it is one of the common complicated urinary tract infections treated in our OPAT unit requiring 10–14 days of parenteral therapy with an agent active against various Gram-negative bacilli and multidrug-resistant organisms. One hundred patients were retrospectively studied based on whether antibiotics were administered during hospital stay alone (hospital only), during both hospital stay, and also as OPAT post discharge (hospital/OPAT) or as OPAT alone (OPAT only). Response to ertapenem and cost of treatment in inpatient versus OPAT settings were compared using Pearson's Chi-square or Fisher's exact test for categorical variables. ANOVA (or Kruskal–Wallis) was used for continuous variables. Baseline urine cultures were ESBL positive with 98% prevalence of Gram-negative bacilli (GNB). Colony counts were ≥100,000 in 74% patients. Only ertapenem, imipenem, and meropenem showed 100% sensitivity to ESBL-positive GNB in baseline urine culture and sensitivity reports. Ertapenem showed 100% sensitivity and complete clinical resolution for 96% patients with APN due to ESBL Enterobacteriaceae. It was administered as OPAT in 90% patients and significantly reduced overall treatment costs.
Collapse
Affiliation(s)
- V Ramasubramanian
- Department of Infectious Disease & Tropical Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - P Murlidharan
- Department of Nephrology, KIMS, Thiruvananthapuram, Kerala, India
| | - S Nambi
- Department of Infectious Disease & Tropical Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - S Pavithra
- Apollo Research & Innovations, Chennai, Tamil Nadu, India
| | - S Puthran
- Medical Affairs, MSD Pharmaceuticals Pvt. Ltd., Mumbai, Maharashtra, India
| | - T Petigara
- Global Health Outcomes, Merck and Co., Inc., Kenilworth, NJ, USA
| |
Collapse
|
12
|
Wang SS, Ratliff PD, Judd WR. Retrospective review of ceftriaxone versus levofloxacin for treatment of E. coli urinary tract infections. Int J Clin Pharm 2017; 40:143-149. [DOI: 10.1007/s11096-017-0560-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/06/2017] [Indexed: 01/07/2023]
|
13
|
Nicolle LE. Complicated Urinary Infection, Including Postsurgical and Catheter-Related Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
14
|
Dizbay M, Özger HS, Karaşahin Ö, Karaşahin EF. Treatment efficacy and superinfection rates in complicated urinarytract infections treated with ertapenem or piperacillin tazobactam. Turk J Med Sci 2016; 46:1760-1764. [PMID: 28081324 DOI: 10.3906/sag-1506-157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/16/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM In this retrospective study, the efficacy of ertapenem and piperacillin tazobactam was compared in the treatment of complicated urinary tract infections (cUTIs). Treatment responses were also evaluated for both antibiotics. MATERIALS AND METHODS A total of 230 patients were enrolled in the study. Of these, 170 received ertapenem and 60 received piperacillin-tazobactam. RESULTS In both groups, urine cultures after 48 h were negative for the initial uropathogen. The frequency of superinfection was 29.4% in the ertapenem group and 8.3% in the piperacillin-tazobactam group over the duration of treatment (P < 0.05). Urinary catheterization increased the superinfection risk 2.88-fold in the ertapenem group and diabetes mellitus increased the risk 8.50-fold in the piperacillin-tazobactam group (CI: 1.44-5.76 and 1.16-62.09, respectively, P < 0.05). The main pathogen isolated from superinfection in the ertapenem group after 48 h was Enterococcus spp. (71.4%). CONCLUSION Both ertapenem and piperacillin-tazobactam were effective in the treatment of cUTIs caused by ESBL-producing microorganisms. A high frequency of superinfection in the ertapenem group was the result of Enterococcus and Pseudomonas spp., against which ertapenem is not active. In the presence of urinary catheterization, diabetes mellitus, and urological intervention, patients should be closely monitored for the development of a superinfection, especially patients receiving ertapenem.
Collapse
Affiliation(s)
- Murat Dizbay
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey
| | | | - Ömer Karaşahin
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey
| | | |
Collapse
|
15
|
Veve MP, Wagner JL, Kenney RM, Grunwald JL, Davis SL. Comparison of fosfomycin to ertapenem for outpatient or step-down therapy of extended-spectrum β-lactamase urinary tract infections. Int J Antimicrob Agents 2016; 48:56-60. [DOI: 10.1016/j.ijantimicag.2016.04.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/28/2016] [Accepted: 04/02/2016] [Indexed: 11/26/2022]
|
16
|
Dariane C, Amin A, Lortholary O, Lalli A, Michel C, Le Guilchet T, Treluyer JM, Nguyen-Khoa T, De Toma C, Urien S, Méjean A, Bourget P, Timsit MO. Plasma and intraprostatic concentrations of ertapenem following preoperative single dose administration: a single-centre prospective experience and clinical implications-the ERTAPRO study. Int J Antimicrob Agents 2016; 48:168-74. [PMID: 27324263 DOI: 10.1016/j.ijantimicag.2016.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 11/25/2022]
Abstract
The incidence of urinary tract infections caused by extended-spectrum β-lactamase (ESBL)-producing pathogens is increasing. These infections are associated with a long hospital stay in patients undergoing urological procedures. We aimed to demonstrate that significant intraprostatic diffusion of ertapenem is achieved after a single preoperative administration. A referred sample of 19 patients requiring surgery for benign prostatic hyperplasia was prospectively included. Patients received a 1 g intravenous (i.v.) dose of ertapenem 1 h (n = 10, group A) or 12 h (n = 9, group B) before blood and prostatic samples were collected. Plasma and intraprostatic concentrations of ertapenem were measured using LC-MS/MS. Intraprostatic concentrations were considered satisfactory when higher than the MIC90 value of urinary-targeted pathogens perioperatively and for 40% of the dosing interval. The Wilcoxon test and a pharmacokinetic predictive model were used. Median plasma concentrations of ertapenem were 144.3 mg/L (95% CI 126.5-157.9) in group A and 30.7 mg/L (95% CI 22.9-36.4) in group B (P < 0.001); median intraprostatic concentrations were 16.6 mg/L (95% CI 13.3-31.4 mg/L) and 4.2 mg/L (95% CI 3.1-4.9 mg/L), respectively (P < 0.001), which were above the MIC90 values of bacteria, including ESBL-producers, during surgery and for 40% of the dosing interval. The plasma-to-prostate concentration ratio was not significantly different between groups (P = 0.97). Single-dose i.v. ertapenem reached satisfactory intraprostatic concentrations, suggesting that it could be a relevant prophylactic strategy for carriers of ESBL-producing bacteria undergoing prostatic procedures, which needs to be confirmed by further prospective trials.
Collapse
Affiliation(s)
- Charles Dariane
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (AP-HP), 20-40 rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France
| | - Alexandre Amin
- Clinical Pharmacy Department, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France; Department of Infectious and Tropical Diseases, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - Alexandre Lalli
- Clinical Pharmacy Department, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France
| | - Constance Michel
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (AP-HP), 20-40 rue Leblanc, 75015 Paris, France
| | - Thomas Le Guilchet
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (AP-HP), 20-40 rue Leblanc, 75015 Paris, France
| | - Jean-Marc Treluyer
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France; Clinical Research Unity, Centre d'investigation clinique, Necker Cochin-Assistance Publique-Hôpitaux de Paris, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France
| | - Thao Nguyen-Khoa
- Laboratory of Biochemistry, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France
| | - Claudia De Toma
- Biological Resources Center and Tumor Bank Platform (BB-0033-00063), Hôpital européen Georges-Pompidou, AP-HP, 20-40 rue Leblanc, 75015 Paris, France
| | - Saïk Urien
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France; Clinical Research Unity, Centre d'investigation clinique, Necker Cochin-Assistance Publique-Hôpitaux de Paris, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France; Clinical Research Unity, Hôpital Tarnier, AP-HP, 89 rue d'Assas, 75006 Paris, France
| | - Arnaud Méjean
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (AP-HP), 20-40 rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France
| | - Philippe Bourget
- Clinical Pharmacy Department, HU Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75746 Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (AP-HP), 20-40 rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'École de Médecine, 75006 Paris, France.
| |
Collapse
|
17
|
Chang UI, Kim HW, Wie SH. Comparison of Second- and Third-Generation Cephalosporin as Initial Therapy for Women with Community-Onset Uncomplicated Acute Pyelonephritis. Yonsei Med J 2015; 56:1266-73. [PMID: 26256969 PMCID: PMC4541656 DOI: 10.3349/ymj.2015.56.5.1266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN). MATERIALS AND METHODS This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime. RESULTS There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140). CONCLUSION Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.
Collapse
Affiliation(s)
- U-Im Chang
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
18
|
Chang UI, Kim HW, Noh YS, Wie SH. A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis. Korean J Intern Med 2015; 30:372-83. [PMID: 25995668 PMCID: PMC4438292 DOI: 10.3904/kjim.2015.30.3.372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. METHODS Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. RESULTS Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm(3) in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). CONCLUSIONS Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.
Collapse
Affiliation(s)
- U-Im Chang
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-sun Noh
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|