Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections

Anderson, Daniel T.; Albrecht, Benjamin; Jones, Keith A.; Jacob, Jesse T; Sexton, Mary Elizabeth; Wiley, Zanthia; Dube, William C; Lee, Benjamin; Suchindran, Sunil

doi:10.1093/ofid/ofac034

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Notably, inappropriate therapy had a protective effect in the study, which was also observed throughout the sensitivity analysis, possibly because patients at lower risk were discharged without changing antibiotics, regardless of susceptibility. In patients infected by multidrug-resistant microorganisms, such as those that produce extended-spectrum beta-lactamases, this resistance pattern seems not to have a deleterious effect on urinary tract infections [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Inappropriate Treatment in Hospitalized Patients with Pyelonephritis Treated with Cefuroxime: A Cohort Study

Cortés,

Sierra,

Sánchez

2024

Antibiotics

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The aim of this study was to evaluate the effect of inappropriate therapy in adult patients with community-acquired pyelonephritis caused by Escherichia coli receiving empirical treatment with cefuroxime during hospital stay and readmission. A retrospective cohort study was performed. Inappropriate treatment was considered treatment for a nonsusceptible isolate according to the results of the urine culture. Adjustment for confounding factors was performed with propensity score-derived inverse probability of treatment weighting. Between 2013 and 2020, 747 patients were included, 102 (13.7%) of whom received inappropriate therapy. Compared to appropriate therapy, inappropriate therapy was associated with a shorter length of stay in the adjusted analysis (Hazard Ratio = 0.34; 95% CI = 0.23–0.49). After 735 patients were discharged from the hospital, 66 were readmitted in the following 30 days. In comparison with appropriate therapy, inappropriate antimicrobial therapy was not related to readmission (OR 1.47; 95% CI = 0.35–2.79). Inappropriate therapy was not related to a longer hospital stay or readmission due to pyelonephritis after adjusting for confounders and covariates.

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Section: Discussionmentioning

confidence: 99%

Effect of Inappropriate Treatment in Hospitalized Patients with Pyelonephritis Treated with Cefuroxime: A Cohort Study

Cortés,

Sierra,

Sánchez

2024

Antibiotics

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“…Our data add to recent evidence that noncarbapenem therapy may have a certain role in the management of ceftriaxone-resistant Enterobacterales infections. 8 , 9 Anderson et al 9 conducted a similar retrospective cohort comparing noncarbapenem β-lactams to carbapenems for the management of ceftriaxone-resistant Enterobacterales infections; however, their analysis was confined to infections of the urinary tract. They included 492 patients (35% with noncarbapenem β-lactam therapy vs 65% with carbapenem therapy).…”

Section: Discussionmentioning

confidence: 99%

“…6 , 7 Additionally, there are likely scenarios in which noncarbapenem β-lactams and other antibiotics may be useful in the management of ceftriaxone-resistant E. coli , K. pneumoniae , and P. mirabilis infections. 5 , 8 , 9 We designed a single-center, retrospective, cohort study to determine the safety of noncarbapenem versus carbapenem antibiotics for the treatment of adults with documented infection caused by ceftriaxone-resistant E. coli , K. pneumoniae , and P. mirabilis infections outside the urinary tract.…”

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confidence: 99%

Efficacy of noncarbapenem therapy for the treatment of ceftriaxone-resistant Enterobacterales outside the urinary tract

Rausch,

Alby,

Wilson

2024

ASHE

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Objective: To determine the safety of noncarbapenem versus carbapenem antibiotics for treatment of adults with documented infection caused by ceftriaxone-resistant infections outside the urinary tract. Design: Retrospective cohort of adult patients with a documented infection caused by an extended-spectrum β-lactamase (ESBL)–producing organism isolated between January 2018 and October 2021. Setting: An academic tertiary-care center. Patients: Adult patients with a documented infection caused by an ESBL-producing organism outside the urinary tract. Methods: The primary outcome was a composite of treatment failure defined as 30-day mortality, 30-day readmission, microbiological recurrence, and/or clinical worsening requiring antibiotic change. Secondary outcomes included differentiation of primary composite components and postantibiotic Clostridioides difficile infection (CDI). Results: This study included 130 patients. The primary source of infections were bloodstream (67.7%) and caused by Escherichia coli (81.5%). Overall, 101 patients received carbapenem therapy and 29 received noncarbapenem therapy (NCT). NCT was comprised of mainly fluoroquinolones (18 of 29) followed by cefepime (7 of 29). Patients receiving NCT had shorter hospital stays (median, 7 days vs 9 days) and were more often discharged on antibiotics (79.3% vs 50.5%). We did not detect a significant difference in the primary composite outcome of treatment failure for carbapenem (23.8%) versus noncarbapenem treatment (24.2%; P = .967). Secondary outcomes included a numerically higher 30-day mortality rate in the noncarbapenem group compared to the carbapenem group: 4 (13.8%) of 29 versus 4 (3.9%) of 101. We did not detect a difference in rates of CDI. Conclusion: Noncarbapenem therapy may play a role for certain patients with infections caused by ESBL-producing organisms.

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“… 7 Lastly, the largest observational study ( N = 492) showed no difference in the primary outcome of hospital LOS or in rates of microbiological eradication in patients with ESBL UTIs definitively treated with carbapenems versus non-carbapenem β-lactams. 8 However, some significant limitations included the lack of assessment for symptoms upon inclusion and the assumption of clinical response for patients without documentation of improvement, risking inclusion of patients with asymptomatic bacteriuria who may not require treatment.…”

Section: Discussionmentioning

confidence: 99%

Assessing clinical cure of empirical piperacillin/tazobactam for ESBL urinary tract infections (ACCEPT—UTI)

Stefanos

Sakaan

Samarin

et al. 2023

JAC-Antimicrobial Resistance

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Background Data are limited regarding use of piperacillin/tazobactam for ESBL urinary tract infections (UTIs). The objective of this study was to compare clinical outcomes of patients treated empirically with piperacillin/tazobactam versus carbapenems for ESBL UTIs. Methods This retrospective, observational, propensity score-matched study evaluated adults with an ESBL on urine culture. Patients who had UTI symptoms or leukocytosis, and who received a carbapenem or piperacillin/tazobactam empirically for at least 48 h were included. The primary outcome was clinical success within 48 h, defined as resolution of temperature (36–38°C), resolution of symptoms or leukocytosis (WBC <12 × 103/μL) in the absence of documented symptoms, and the absence of readmission for an ESBL UTI within 6 months. Secondary outcomes included time to clinical resolution, hospital length of stay, and in-hospital and 30 day all-cause mortality. Results Overall, 223 patients were included in the full cohort and 200 patients in the matched cohort (piperacillin/tazobactam = 100, carbapenem = 100). Baseline characteristics were similar between the groups. There was no difference in the primary outcome of clinical success between the carbapenem and piperacillin/tazobactam groups (58% versus 56%, respectively; P = 0.76). Additionally, there was no difference in median (IQR) time to clinical resolution [38.9 h (21.5, 50.9 h) versus 40.3 h (27.4, 57.5 h); P = 0.37], in-hospital all-cause mortality (3% versus 3%; P = 1.00), or 30 day all-cause mortality (4% versus 2%; P = 0.68) between the carbapenem and piperacillin/tazobactam groups, respectively. Conclusions There was no significant difference in clinical success for patients treated empirically with piperacillin/tazobactam compared with carbapenems for ESBL UTIs.

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Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections

Cited by 13 publications

References 27 publications

Effect of Inappropriate Treatment in Hospitalized Patients with Pyelonephritis Treated with Cefuroxime: A Cohort Study

Effect of Inappropriate Treatment in Hospitalized Patients with Pyelonephritis Treated with Cefuroxime: A Cohort Study

Efficacy of noncarbapenem therapy for the treatment of ceftriaxone-resistant Enterobacterales outside the urinary tract

Assessing clinical cure of empirical piperacillin/tazobactam for ESBL urinary tract infections (ACCEPT—UTI)

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