Takanori Asakura1, Masayuki Ikeda2, Akira Nakamura3, Satoshi Kodera4. 1. Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: takanori.asakura@gmail.com. 2. Department of Medical Informatics, Kagawa University Hospital, Mikicho, Kagawa, Japan. 3. Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan. 4. Department of Cardiology, Asahi General Hospital, Asahi, Chiba, Japan.
Abstract
OBJECTIVES: Carbapenems are first-line agents for severe infections with extended-spectrum beta-lactamase (ESBL)-producing bacteria. The use of carbapenems, however, is associated with the emergence of resistant organisms. We investigated the effects of empirical therapy with non-carbapenems on urinary tract infections (UTIs) with ESBL-producing Enterobacteriaceae in a hospital where antimicrobial stewardship has been established. METHODS: This retrospective chart review was undertaken at a tertiary care hospital where antimicrobial stewardship and restriction of carbapenems has been established. Patients with a UTI with ESBL-producing Enterobacteriaceae were stratified into susceptible and non-susceptible therapy groups according to the susceptibility of the causative organism to the initial antimicrobial therapy. Outcome measures were the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, and clinical cure. RESULTS: Of 90 patients, 30 (33.3%) exhibited susceptible therapy. However, no significant difference was observed in the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, or clinical cure between the susceptible and non-susceptible groups. Multivariate analyses revealed that the independent risk factor for 14-day morality was the use of immunosuppressive agents (odds ratio 5.23, 95% confidence interval 1.26-24.04; p=0.023). CONCLUSIONS: Non-carbapenem therapy against UTIs with ESBL-producing Enterobacteriaceae does not pose a significant risk to patients who are not taking immunosuppressive agents.
OBJECTIVES:Carbapenems are first-line agents for severe infections with extended-spectrum beta-lactamase (ESBL)-producing bacteria. The use of carbapenems, however, is associated with the emergence of resistant organisms. We investigated the effects of empirical therapy with non-carbapenems on urinary tract infections (UTIs) with ESBL-producing Enterobacteriaceae in a hospital where antimicrobial stewardship has been established. METHODS: This retrospective chart review was undertaken at a tertiary care hospital where antimicrobial stewardship and restriction of carbapenems has been established. Patients with a UTI with ESBL-producing Enterobacteriaceae were stratified into susceptible and non-susceptible therapy groups according to the susceptibility of the causative organism to the initial antimicrobial therapy. Outcome measures were the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, and clinical cure. RESULTS: Of 90 patients, 30 (33.3%) exhibited susceptible therapy. However, no significant difference was observed in the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, or clinical cure between the susceptible and non-susceptible groups. Multivariate analyses revealed that the independent risk factor for 14-day morality was the use of immunosuppressive agents (odds ratio 5.23, 95% confidence interval 1.26-24.04; p=0.023). CONCLUSIONS: Non-carbapenem therapy against UTIs with ESBL-producing Enterobacteriaceae does not pose a significant risk to patients who are not taking immunosuppressive agents.
Authors: Sima L Sharara; Joe Amoah; Zoi D Pana; Patricia J Simner; Sara E Cosgrove; Pranita D Tamma Journal: Clin Infect Dis Date: 2020-11-05 Impact factor: 9.079
Authors: Wellington Francisco Rodrigues; Camila Botelho Miguel; Ana Paula Oliveira Nogueira; Carlos Ueira-Vieira; Tony De Paiva Paulino; Siomar De Castro Soares; Elisabete Aparecida Mantovani Rodrigues De Resende; Javier Emilio Lazo-Chica; Marcelo Costa Araújo; Carlo José Oliveira Journal: Int J Environ Res Public Health Date: 2016-09-15 Impact factor: 3.390