Sendra Elena, López Montesinos Inmaculada, Rodriguez-Alarcón Alicia, Du Juan, Siverio-Parés Ana, Arenas-Miras Mar, Cañas-Ruano Esperanza, Prim Nuria, Durán-Jordà Xavier, Blasco-Hernando Fabiola, García-Alzorriz Enric, Cots Francesc, Ferrández Olivia, Gómez-Zorrilla Silvia
Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
Antibiotics (Basel). 2022 Oct 29;11(11):1511. doi: 10.3390/antibiotics11111511.
The objective was to compare clinical characteristics, outcomes, and economic differences in complicated urinary tract infections (cUTI) caused by extensively drug-resistant Pseudomonas aeruginosa (XDR P. aeruginosa) and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-K. pneumoniae). A retrospective study was conducted at a tertiary care hospital. Patients with XDR P. aeruginosa and ESBL-K. pneumoniae cUTIs were compared. The primary outcome was clinical failure at day 7 and at the end of treatment (EOT). Secondary outcomes: 30- and 90-day mortality, microbiological eradication, and economic cost. Two-hundred and one episodes were included, of which 24.8% were bloodstream infections. Patients with XDR P. aeruginosa cUTI more frequently received inappropriate empirical therapy (p < 0.001). Nephrotoxicity due to antibiotics was only observed in the XDR P. aeruginosa group (26.7%). ESBL-K. pneumoniae cUTI was associated with worse eradication rates, higher recurrence, and higher infection-related readmission. In multivariate analysis, XDR P. aeruginosa was independently associated with clinical failure on day 7 of treatment (OR 4.34, 95% CI 1.71−11.04) but not at EOT, or with mortality. Regarding hospital resource consumption, no significant differences were observed between groups. XDR P. aeruginosa cUTI was associated with worse early clinical cures and more antibiotic side effects than ESBL-K. pneumoniae infections. However, no differences in mortality or in hospitalization costs were observed.
目的是比较由广泛耐药铜绿假单胞菌（XDR铜绿假单胞菌）和产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-肺炎克雷伯菌）引起的复杂性尿路感染（cUTI）的临床特征、结局和经济差异。在一家三级护理医院进行了一项回顾性研究。对XDR铜绿假单胞菌和ESBL-肺炎克雷伯菌cUTI患者进行了比较。主要结局是第7天和治疗结束时（EOT）的临床失败。次要结局：30天和90天死亡率、微生物清除率和经济成本。纳入了201例病例，其中24.8%为血流感染。XDR铜绿假单胞菌cUTI患者更频繁地接受了不恰当的经验性治疗（p<0.001）。仅在XDR铜绿假单胞菌组观察到抗生素引起的肾毒性（26.7%）。ESBL-肺炎克雷伯菌cUTI与较差的清除率、较高的复发率和较高的感染相关再入院率相关。在多变量分析中，XDR铜绿假单胞菌与治疗第7天的临床失败独立相关（OR 4.34，95%CI 1.71−11.04），但与EOT时或死亡率无关。关于医院资源消耗，两组之间未观察到显著差异。与ESBL-肺炎克雷伯菌感染相比，XDR铜绿假单胞菌cUTI与较差的早期临床治愈率和更多的抗生素副作用相关。然而，在死亡率或住院费用方面未观察到差异。
