Treatment efficacy and superinfection rates in complicated urinarytract infections treated with ertapenem or piperacillin tazobactam

Dizbay, Murat; Özger, Hasan Selçuk; Karaşahin, Ömer; Karaşahin, Emine Füsun

doi:10.3906/sag-1506-157

Cited by 21 publications

(14 citation statements)

References 10 publications

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“…Treatment with a BLBLI was not shown to be associated with worse outcomes than those with carbapenems in multivariate analysis or after propensity score matching of patients. Other studies that included only UTI showed similar results (54,55). An open randomized controlled trial performed in 3 hospitals compared the efficacies of piperacillin-tazobactam (4.5 g every 6 h) and ertapenem (1 g per day) in patients with UTI due to ESBL-E (56).…”

Section: Classic Blblismentioning

confidence: 91%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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Therapy of invasive infections due to multidrug-resistant (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.

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Section: Classic Blblismentioning

confidence: 91%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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“…Carbapenems like imipenem represent the best option for the treatment of extended-spectrum beta-lactamase (ESBL) strains (Idil et al, 2016 ). UPEC strains are also susceptible to ciprofloxacin (Tosun et al, 2016 ), cefotaxime, piperacillin/tazobactam (Dizbay et al, 2016 ), azithromycin, doxycycline and ceftriaxone (Saha et al, 2015 ). However, several UPEC isolates are resistant to ampicillin, oral first-generation cephalosporins, TMP-sulfamethoxazole (Moya-Dionisio et al, 2016 ), cefuroxime (Chang et al, 2016 ), cotrimoxazole (Saha et al, 2015 ), amoxicillin-clavulanate, nalidixic acid, cefradine, and aminopenicillins (Narchi and Al-Hamdani, 2010 ).…”

Section: Upec Antibiotic Susceptibility and Resistancementioning

confidence: 99%

UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies

2017

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Urinary tract infections (UTIs) are one of the most common pathological conditions in both community and hospital settings. It has been estimated that about 150 million people worldwide develop UTI each year, with high social costs in terms of hospitalizations and medical expenses. Among the common uropathogens associated to UTIs development, UroPathogenic Escherichia coli (UPEC) is the primary cause. UPEC strains possess a plethora of both structural (as fimbriae, pili, curli, flagella) and secreted (toxins, iron-acquisition systems) virulence factors that contribute to their capacity to cause disease, although the ability to adhere to host epithelial cells in the urinary tract represents the most important determinant of pathogenicity. On the opposite side, the bladder epithelium shows a multifaceted array of host defenses including the urine flow and the secretion of antimicrobial substances, which represent useful tools to counteract bacterial infections. The fascinating and intricate dynamics between these players determine a complex interaction system that needs to be revealed. This review will focus on the most relevant components of UPEC arsenal of pathogenicity together with the major host responses to infection, the current approved treatment and the emergence of resistant UPEC strains, the vaccine strategies, the natural antimicrobial compounds along with innovative anti-adhesive and prophylactic approaches to prevent UTIs.

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“…Ertapenem is a common choice of antibiotic for ESBL-producing bacteria. 13,14,18,19 It is licensed in Turkey for various indications including complicated UTIs. 20 Once a day dosing of the antibiotic makes it convenient for OPAT.…”

Section: Discussionmentioning

confidence: 99%

Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID‐19 pandemic

et al. 2021

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Background: Physicians hospitalize the patients with complicated urinary tract infections (cUTIs) when they need intravenous antibiotics and outpatient parenteral antimicrobial therapy (OPAT) is unavailable. Daily inpatient antimicrobial therapy is an alternative to hospitalization, which is similar to OPAT; patients go home after they are administered antibiotics in a separate room in the hospital setting.Objectives: We assessed our previous daily inpatient practice to revitalize the model in the COVID-19 era. Materials and Methods:We retrospectively evaluated the clinical and microbiological responses and the cost effectiveness of the patients with cUTIs who received daily inpatient ertapenem therapy. Results:Our study population was 136 patients in 156 episodes. It was a difficultto-treat group with older age (mean 63.0 ± 14.8 years) and a high burden of underlying conditions (86.5%). The most common causative organisms were Escherichia coli (74.4%) and Klebsiella pneumoniae (19.2%); 89.7% of the isolates were producing extended-spectrum beta lactamase (ESBL). The microbiologic and clinical success rates were 82.1% and 95.5%, respectively. The patients required hospitalization in 16 episodes (10.2%) because of clinical failures (3.8%), superinfections (2%), planned invasive interventions (3.2%), and side effects (1.2%). Our university hospital saved 1608 bed-days and 2596 € (9702 TL) bed costs. Conclusions:In the COVID-19 pandemic period, this seems to be an effective, safe, and cost-effective way to decrease hospitalizations for cUTIs in settings where OPAT is unavailable. What's known• Antimicrobial resistance in the complicated urinary tract infections is a global challenge for optimal antimicrobial treatment.• Hospitalization of these patients has increased the cost, risk of transmissions of COVID-19, and infections.• Ertapenem is suitable for outpatient parenteral antimicrobial therapy (OPAT).How to cite this article: Nazli Zeka A, Avkan-Oguz V, Irmak C, et al. Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID-19 pandemic. Int J Clin Pract.

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Treatment efficacy and superinfection rates in complicated urinarytract infections treated with ertapenem or piperacillin tazobactam

Cited by 21 publications

References 10 publications

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies

Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID‐19 pandemic

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