White Cassandra R, Jodlowski Tomasz Z, Atkins Dylan T, Holland Nicole G
1 Husson University School of Pharmacy, Bangor, ME, USA.
2 VA Maine Healthcare System, Augusta, ME, USA.
J Pharm Pract. 2017 Aug;30(4):464-467. doi: 10.1177/0897190016642362. Epub 2016 Apr 12.
To report on a patient with a symptomatic, polymicrobial Escherichia coli and multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)-positive Klebsiella pneumoniae urinary tract infection (UTI) who was successfully treated with oral doxycycline hyclate.
A 70-year-old white male inpatient with a history of recurrent UTI, type 2 diabetes, hypertension, obesity, and diverticular disease was diagnosed with UTI and empirically treated with oral ciprofloxacin. Symptoms persisted 2 days later, and the patient was transitioned to amoxicillin/clavulanate by a different provider. The next day, upon receipt of the urine culture and susceptibility panel revealing E coli and MDR, ESBL-positive K pneumoniae infection, treatment was switched to doxycycline hyclate, which resulted in clinical improvement.
Complicated UTI involving multiple pathogens requires careful clinical judgment to select the appropriate antimicrobial agent, improve clinical outcomes, and prevent resistance. Treatment with doxycycline was based on the susceptibility panel and local resistance patterns. Advantages of doxycycline for UTI include its oral formulation, wide spectrum of activity, ability to achieve high concentration in the urine, and low toxicity.
Doxycycline hyclate may be an effective treatment option for patients with susceptible MDR UTI.
报告一例有症状的、由多种微生物引起的大肠杆菌以及耐多药（MDR）、产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌尿路感染（UTI）患者，该患者经口服盐酸多西环素成功治愈。
一名70岁的白人男性住院患者，有复发性UTI、2型糖尿病、高血压、肥胖症和憩室病病史，被诊断为UTI，并经验性地接受口服环丙沙星治疗。两天后症状持续存在，另一位医生将该患者的治疗改为阿莫西林/克拉维酸。第二天，在收到尿培养及药敏结果显示为大肠杆菌和耐多药、产ESBL的肺炎克雷伯菌感染后，治疗改为盐酸多西环素，临床症状得到改善。
涉及多种病原体的复杂性UTI需要仔细的临床判断，以选择合适的抗菌药物，改善临床结局并防止耐药性。使用多西环素治疗是基于药敏结果和当地的耐药模式。多西环素用于UTI的优点包括其口服剂型、广泛的活性谱、在尿液中达到高浓度的能力以及低毒性。
盐酸多西环素可能是治疗敏感的耐多药UTI患者的有效选择。
