Korean J healthc assoc Infect Control Prev.  2016 Dec;21(2):50-56. 10.14192/kjhaicp.2016.21.2.50.

Use of Non-carbapenem Antibiotics in Patients with Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Enterobacteriaceae

• Seo YB
• Kim YK
• Lee J
• Song W

• KMID: 2362897
• DOI: http://doi.org/10.14192/kjhaicp.2016.21.2.50

Abstract

BACKGROUND
Alternatives to carbapenem are increasingly needed to decrease the usage of carbapenem. We evaluated the possibility of using non-carbapenem antibiotics against urinary tract infections (UTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE).
METHODS
This retrospective study was performed at 2 university hospitals between October 2010 and December 2012. All diagnosed adult cases of ESBL-PE UTI were identified from the microbiological database. The subjects were divided into 3 groups based on the empirical antibiotic classes and susceptibility: carbapenem (C) group, susceptible non-carbapenem (SNC) group, and non-susceptible non-carbapenem (NSNC) group.
RESULTS
A total of 84 patients were eligible for analysis. For empirical therapy, 41, 23, and 20 patients were included in the NSNC, SNC, and C empirical groups, respectively. During the empirical therapy, 7 patients (17.1%) in the NSNC group, 18 patients (78.3%) in the SNC group, and 19 patients (78.3%) in the C group experienced clinical improvement. No significant difference was observed between the SNC and C empirical groups (P=0.192). Severe sepsis or shock was the predictor of empirical SNC treatment failure (P=0.048). There was a tendency to use carbapenem as a definite therapy in cases of NSNC. In contrast, empirical SNC was maintained as a definite therapy.
CONCLUSION
SNC could be considered as an alternative to carbapenems for treating ESBL-PE UTI. This strategy might decrease the usage of carbapenem without clinical deterioration. However, it should be noted that SNC therapy may fail in the case of severe sepsis or shock.

Keyword

Carbapenem; Extended-spectrum beta-lactamase; Urinary tract infection

MeSH Terms

Adult
Anti-Bacterial Agents*
Carbapenems
Enterobacteriaceae*
Hospitals, University
Humans
Retrospective Studies
Sepsis
Shock
Treatment Failure
Urinary Tract Infections*
Urinary Tract*
Anti-Bacterial Agents
Carbapenems

Figure

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  Figure 1. Flow chart describing the process for patient selection.

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