Long-term outcomes of inappropriate antibiotic therapy for upper urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: a retrospective cohort study
| Autor: | Inbal Greenhouse, Moran Aliman, Frida Babushkin, Zvi Shimoni, Talya Finn, Ronen Ben-Ami, Regev Cohen |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Carbapenem medicine.medical_treatment 030106 microbiology Urine Drug Prescriptions beta-Lactamases Cohort Studies 03 medical and health sciences 0302 clinical medicine Enterobacteriaceae Internal medicine Drug Resistance Bacterial mental disorders medicine Humans 030212 general & internal medicine Urinary tract infection (UTI) Aged Retrospective Studies First episode business.industry Mortality rate Enterobacteriaceae Infections Retrospective cohort study General Medicine medicine.disease Antimicrobial nervous system diseases Surgery Treatment Outcome Infectious Diseases nervous system Urinary Tract Infections Beta-lactamase business medicine.drug |
| Zdroj: | Diagnostic Microbiology and Infectious Disease. 89:222-229 |
| ISSN: | 0732-8893 |
| DOI: | 10.1016/j.diagmicrobio.2017.07.011 |
| Popis: | To evaluate the short- and long-term outcomes of different antimicrobial treatment options for upper urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.We retrospectively analyzed patients with a first episode of febrile UTI and positive urine culture with ESBL-producing E. coli or K. pneumoniae during 2012-2015. We compared outcomes among patients who received: (1) definitive treatment with a carbapenem (CP), (2) a microbiologically appropriate intravenous non-carbapenem agent (NCA), (3) a non-appropriate antimicrobial (NAA), and (4) an intravenous NAA followed by an oral NCA (NAA-PO).The majority of patients received empirical therapy with NAA (165/178, 93%), and definitive treatment with NCA (n=43), NAA (n=50), and NAA-PO (n=59). The NCA group had significantly higher SIRS score than the NAA-PO group (2.18 versus 1.76, P=0.018), but no differences were found between the NCA and NAA groups (2.18 and 1.92, P=0.15). Clinical cure at discharge from the index hospitalization was high (97-100%) in all 3 groups. The NCA group had longer length of stay as compared with the NAA-PO and NAA groups (8.7days versus 5.39 and 5.24days, P0.0001) and a lower rate of early (48-72h) improvement (79% versus 96-100%, P=0.0002). Among re-admitted patients, re-admission with ESBL-related bloodstream infection was significantly higher in the NAA group as compared to the NAA-PO and NCA groups (33% versus 4% and 0%, respectively, P=0.02). Death rate within 60days was also higher in the NAA and NCA groups as compared with the NAA-PO group (P=0.048).Inappropriate antimicrobial therapy for febrile non-bacteremic UTI with ESBL-producing enterobacteriaceae is associated with favorable short-term outcomes, but also with a long-term risk of relapsed bacteremic UTI. Definitive treatment with appropriate carbapenem-sparing antimicrobial agents effectively prevents late relapses. |
| Databáze: | OpenAIRE |
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