White C Whitney, Kyle Jeffrey A, Deas Crystal M, Campbell Jacob
From the University of Mississippi School of Pharmacy, Jackson, the Samford University McWhorter School of Pharmacy, Birmingham, Alabama, and Madison Hospital, Madison, Alabama.
South Med J. 2019 Aug;112(8):438-443. doi: 10.14423/SMJ.0000000000001002.
Urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing are resistant to many conventional therapies, including third-generation cephalosporins. Carbapenems are considered first-line agents for ESBL infections, but their use is associated with increased multidrug resistance and should be reserved when absolutely necessary. Because of the increased rates of UTIs caused by ESBL-producing organisms and incidence of carbapenem resistance, safe and effective alternatives to carbapenems are needed. This study was conducted to evaluate the outcomes associated with the treatment of ESBL UTIs with noncarbapenem antibiotics.
A retrospective cohort study of adults with ESBL UTIs was conducted at a community hospital. Patients were categorized as those receiving definitive carbapenem therapy and those receiving definitive noncarbapenem therapy. Calculated measurements included infection-related mortality, length of hospital stay, and duration of definitive antibiotic therapy. Microbiological failure was assessed as a secondary outcome. Data on the safety of antibiotic therapy were not collected. < 0.05 was considered significant.
Fifty patients met inclusion criteria for the study, divided evenly between the two cohorts. No statistical differences were observed for length of hospital stay ( = 0.601), duration of therapy ( = 0.398), or rate of microbiological failure between the groups ( = 0.115).
Noncarbapenems did not demonstrate significant differences compared with carbapenems in the treatment of adults with ESBL UTIs. In certain patient populations, noncarbapenems that demonstrate in vitro activity may be appropriate for UTIs caused by ESBL-producing organisms.
由产超广谱β-内酰胺酶（ESBL）的细菌引起的尿路感染（UTIs）对包括第三代头孢菌素在内的许多传统疗法均具有耐药性。碳青霉烯类药物被视为治疗ESBL感染的一线药物，但其使用会增加多重耐药性，因此应仅在绝对必要时使用。由于产ESBL细菌引起的UTIs发病率上升以及碳青霉烯类耐药的发生率增加，需要有安全有效的碳青霉烯类替代药物。本研究旨在评估使用非碳青霉烯类抗生素治疗ESBL UTIs的疗效。
在一家社区医院对患有ESBL UTIs的成人进行了一项回顾性队列研究。患者被分为接受确定性碳青霉烯类治疗的患者和接受确定性非碳青霉烯类治疗的患者。计算的指标包括感染相关死亡率、住院时间和确定性抗生素治疗的持续时间。微生物学治疗失败作为次要结局进行评估。未收集抗生素治疗安全性的数据。P < 0.05被认为具有统计学意义。
50名患者符合该研究的纳入标准，两组各占一半。两组之间在住院时间（P = 0.601）、治疗持续时间（P = 0.398）或微生物学治疗失败率（P = 0.115）方面未观察到统计学差异。
在治疗患有ESBL UTIs的成人患者时，非碳青霉烯类药物与碳青霉烯类药物相比未显示出显著差异。在某些患者群体中，具有体外活性的非碳青霉烯类药物可能适用于由产ESBL细菌引起的UTIs。
