Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Juliana Van Stolberglaan 13, 1814HB, Alkmaar, The Netherlands.
Department of Medical Microbiology, Haaglanden MC, The Hague, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2018 Oct;37(10):2021-2025. doi: 10.1007/s10096-018-3338-z. Epub 2018 Aug 16.
This study aimed to evaluate the clinical and bacteriological effect of oral treatment with ceftibuten plus amoxicillin-clavulanic acid in patients with a urinary tract infection (UTI) caused by an extended-spectrum β-lactamase (ESBL)-producing micro-organism. In this retrospective observational case-series, oral treatment with ceftibuten 400 mg QD plus amoxicillin-clavulanic acid 625 mg TID for 14 days was evaluated in ten patients with pyelonephritis caused by an ESBL-positive micro-organism resistant to ciprofloxacin and co-trimoxazole. Presence of ESBL genes was confirmed using PCR and micro-array. EUCAST breakpoints were used for susceptibility testing. Ten patients (five women) were evaluated in 2016 and 2017. Six patients were from outpatient hospital care, and four from primary care. Urinary cultures yielded seven E. coli and three K. pneumoniae ESBL-positive isolates. Using Vitek-2, all isolates were resistant to cefotaxime, and resistant (n = 7) or intermediately susceptible (n = 3) to ceftazidime. With disc diffusion, all isolates were susceptible to ceftibuten (zones 25-32 mm), while with MIC test strips eight of ten isolates were resistant to ceftibuten (MICs 0.5-4 mg/L). An amoxicillin-clavulanic acid disc next to the ceftibuten disc extended the ceftibuten zone by 2-8 mm. All patients experienced clinical cure. Bacteriological cure (absence of pretreatment micro-organism in the first follow-up culture obtained within 3 months after treatment) was observed in all eight patients with follow-up cultures. This case-series shows that the synergistic combination of ceftibuten plus amoxicillin-clavulanic acid may be an option for oral treatment of UTIs caused by ESBL producing E. coli or K. pneumoniae.
本研究旨在评估口服头孢替坦加阿莫西林克拉维酸治疗产超广谱β-内酰胺酶（ESBL）微生物引起的尿路感染（UTI）的临床和细菌学疗效。在这项回顾性观察性病例系列研究中，评估了 10 例由对环丙沙星和复方磺胺甲噁唑耐药的 ESBL 阳性微生物引起的肾盂肾炎患者使用口服头孢替坦 400mg QD 加阿莫西林克拉维酸 625mg TID 治疗 14 天的疗效。使用 PCR 和微阵列法确认 ESBL 基因的存在。采用 EUCAST 折点进行药敏试验。2016 年和 2017 年共评估了 10 例患者（5 例女性）。6 例患者来自门诊医院护理，4 例来自初级保健。尿培养产生了 7 株大肠埃希菌和 3 株肺炎克雷伯菌 ESBL 阳性分离株。使用 Vitek-2，所有分离株均对头孢噻肟耐药，对头孢他啶耐药（n=7）或中介敏感（n=3）。用纸片扩散法，所有分离株均对头孢替坦敏感（抑菌环直径 25-32mm），而用 MIC 测试条，10 个分离株中有 8 个对头孢替坦耐药（MIC 为 0.5-4mg/L）。头孢替坦纸片旁边放置阿莫西林克拉维酸纸片可使头孢替坦抑菌环扩大 2-8mm。所有患者均获得临床治愈。8 例有随访培养的患者在治疗后 3 个月内获得的首次随访培养中均未检出预处理微生物，观察到细菌学治愈。本病例系列研究表明，头孢替坦加阿莫西林克拉维酸的协同组合可能是治疗产 ESBL 的大肠埃希菌或肺炎克雷伯菌引起的 UTI 的口服治疗选择。
