A de La Blanchardière1, S Dargère2, F Guérin3, C Daurel3, G Saint-Lorant4, R Verdon2, V Cattoir3. 1. Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: delablanchardiere-a@chu-caen.fr. 2. Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France. 3. Service de microbiologie, CHU de Caen, Caen, France. 4. Service de pharmacie, CHU de Caen, Caen, France.
Abstract
PURPOSE: We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems. METHODS: The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months. RESULTS: Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia. CONCLUSIONS: Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients.
PURPOSE: We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems. METHODS: The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months. RESULTS: Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia. CONCLUSIONS: Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients.
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: L Surgers; A Boyd; P-Y Boelle; V Lalande; P-A Jolivot; P-M Girard; G Arlet; C Cambier; A Homor; D Decre; J-L Meynard Journal: Eur J Clin Microbiol Infect Dis Date: 2017-02-08 Impact factor: 3.267