Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID‐19 pandemic

Abstract

Background: Physicians hospitalize the patients with complicated urinary tract infections (cUTIs) when they need intravenous antibiotics and outpatient parenteral antimicrobial therapy (OPAT) is unavailable. Daily inpatient antimicrobial therapy is an alternative to hospitalization, which is similar to OPAT; patients go home after they are administered antibiotics in a separate room in the hospital setting.Objectives: We assessed our previous daily inpatient practice to revitalize the model in the COVID-19 era. Materials and Methods:We retrospectively evaluated the clinical and microbiological responses and the cost effectiveness of the patients with cUTIs who received daily inpatient ertapenem therapy. Results:Our study population was 136 patients in 156 episodes. It was a difficultto-treat group with older age (mean 63.0 ± 14.8 years) and a high burden of underlying conditions (86.5%). The most common causative organisms were Escherichia coli (74.4%) and Klebsiella pneumoniae (19.2%); 89.7% of the isolates were producing extended-spectrum beta lactamase (ESBL). The microbiologic and clinical success rates were 82.1% and 95.5%, respectively. The patients required hospitalization in 16 episodes (10.2%) because of clinical failures (3.8%), superinfections (2%), planned invasive interventions (3.2%), and side effects (1.2%). Our university hospital saved 1608 bed-days and 2596 € (9702 TL) bed costs. Conclusions:In the COVID-19 pandemic period, this seems to be an effective, safe, and cost-effective way to decrease hospitalizations for cUTIs in settings where OPAT is unavailable. What's known• Antimicrobial resistance in the complicated urinary tract infections is a global challenge for optimal antimicrobial treatment.• Hospitalization of these patients has increased the cost, risk of transmissions of COVID-19, and infections.• Ertapenem is suitable for outpatient parenteral antimicrobial therapy (OPAT).How to cite this article: Nazli Zeka A, Avkan-Oguz V, Irmak C, et al. Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID-19 pandemic. Int J Clin Pract.

Pivmecillinam with Amoxicillin/Clavulanic acid as Step Down Oral Therapy in Febrile Urinary Tract Infections Caused by ESBL-producing Enterobacterales (PACUTI)

“…Ertapenem has been evaluated in at least 4 randomised controlled trials (RCTs) and proved equally effective and tolerable for the treatment of complicated UTI as a traditional treatment with a third-generation cephalosporin (31)(32)(33). Ertapenem is widely used as once daily intravenous out-patient treatment of EPE-caused febrile UTIs with retrospective data supporting good clinical outcomes (34,35) that are comparable to TMX (36).…”

Pivmecillinam with Amoxicillin/Clavulanic acid as step down oral therapy in febrile Urinary Tract Infections caused by ESBL-producing Enterobacterales (PACUTI)

“…Ertapenem has been evaluated in at least 4 randomised controlled trials (RCTs) and proved equally effective and tolerable for the treatment of complicated UTI as a traditional treatment with a third-generation cephalosporin [ 31 – 33 ]. Ertapenem is widely used as once daily intravenous outpatient treatment of EPE-caused febrile UTIs with retrospective data supporting good clinical outcomes [ 34 , 35 ] that are comparable to TMX [ 36 ].…”

Clinical, organizational, and pharmacoeconomic perspectives of dalbavancin vs standard of care in the infectious disease network

“…It is used for patients with severe or deep infections requiring prolonged parenteral antibiotic treatment, who are now clinically stabilized without the need for prolonged hospitalization for other reasons. OPAT allows (i) rapid discharge home (early discharge), with a reduction in the risk of contracting nosocomial infections and a notable (up to 70% for the individual case) saving of economic resources ( 9 ), (ii) dehospitalization in patients who do not require hospitalization and day-hospital care ( 3 - 10 ). Positive experiences are reported in the treatment of acute bacterial skin and skin structure infection (ABSSSI), serious skin and soft tissue infections, bone and joint infections (BJIs; osteomyelitis, spondylodiscitis, arthritis and prosthetic infections), endocarditis (American, European and English guidelines recommend it as a routine practice) and numerous other infections, including resistant urinary tract and central nervous system infections.…”