Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance

Parienti, Jean‐Jacques; Lucet, Jean Christophe; Lefort, A.; Armand-Lefèvre, Laurence; Wolff, Michel; Caron, François; Cattoir, Vincent; Yazdanpanah, Yazdan

doi:10.1016/j.ajic.2015.05.033

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…Our results support a recent meta-analysis estimation of no definite increase in the risk for mortality in patients of all ages treated with BRIAT on internal medicine wards for upper UTIs 10. Similarly, Peralta et al reported that antibiotic resistance for patients with bacteraemia due to ESBL producing E. coli or Klebsiella spp was not associated with mortality in patients without severe sepsis or septic shock 11…”

Section: Discussionsupporting

confidence: 90%

“…We were thus able to define the potential benefits of a policy of using wide spectrum antibiotics on admission in these selected patients and found that treatment of all patients with amikacin or a carbapenem could potentially decrease the number of hospitalisation days by a median of 3 days in 26% of the patients; this is consistent with the estimate by Parienti et al 10 who assumed 4 extra days of hospitalisation in internal medical department patients who received BRIAT.…”

Section: Discussionsupporting

confidence: 83%

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Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

et al. 2016

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PurposeTo determine the consequences of treating febrile geriatric patients with a suspected urinary tract infection (UTI) with antibiotics that have high resistance rates due primarily to extended-spectrum β-lactamase (ESBL) producing bacteria.MethodsIn this cohort study, we selected 257 consecutive hospitalised patients aged ≥70 years with a chief symptom of fever, possibly due to a UTI and initially treated with antibiotics with rates in our hospital of urinary culture resistance >20%. Patients with severe sepsis were excluded. The main outcomes measures were in vitro bacterial resistance to initial antibiotic therapy (BRIAT), response to therapy, hospitalisation days and mortality.ResultsUrine cultures were positive in 64.2% (165 of 257) of the patients and BRIAT occurred in 28.0% (72 of 257). Response rates were 100% (93 of 93) in those with bacteria sensitive to initial antibiotic therapy, 95.7% (88 of 92) in the culture negative patients, and 66.7% (48 of 72) in those with BRIAT (p<0.001). There were no deaths due to deterioration during the initial treatment period because of BRIAT. In the patients with BRIAT, the median length of hospitalisation was 3 days longer than that in the other patients (7 and 4 days, respectively, p<0.001).ConclusionsWe conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3 days in many hospitalised geriatric patients without an extra-urinary tract source for their fever. This benefit needs to be balanced against the risk to the individual patient and to the general public of increasing bacterial resistance rates to broader spectrum antibiotics often held in reserve.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

et al. 2016

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“…The need for such a model in medical decision making is well established, and it is borne from the need to make resource allocation and clinical management decisions in the absence of complete clinical data. Such tools have been widely used in general health care decision making and specifically used in the evaluation of infection treatment strategies (20,(32)(33)(34). The main limitation of any model is that it combines data from multiple sources and requires assumptions regarding the comparability of data.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities

D’Agata

Tran²,

Bautista

et al. 2018

CJASN

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“…1,2 Notably, the spread of ESBL-producing Enterobacterales, resistant to third-generation cephalosporins and causing both communityacquired and healthcare-associated infections, has led to an increase in consumption of carbapenems. 3,4 More recently, carbapenem-resistant Enterobacterales have emerged worldwide, especially carbapenemase-producing Enterobacterales (CPE), which represent a major therapeutic challenge. 5 CPE often carry plasmids encoding resistance to carbapenems as well as to quinolones, aminoglycosides or co-trimoxazole, 6 leaving few therapeutic options and leading to high mortality rates for CPE infections.…”

Section: Introductionmentioning

confidence: 99%

Dimercaptosuccinic acid in combination with carbapenems against isogenic strains of Escherichia coli producing or not producing a metallo-β-lactamase in vitro and in murine peritonitis

Cheminet

Lastours

Poirel

et al. 2020

Journal of Antimicrobial Chemotherapy

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Background Carbapenemase-producing Enterobacterales represent a major therapeutic challenge. MBLs, requiring zinc at their catalytic site, could be inhibited by meso-dimercaptosuccinic acid (DMSA), a heavy metal chelator already widely used for treating lead intoxication. Objectives To evaluate the activity of carbapenems alone or combined with DMSA against MBL-producing Escherichia coli in a severe murine peritonitis model. Methods Isogenic strains of wild-type E. coli CFT073 producing the MBLs NDM-1, VIM-2 and IMP-1, and the control serine carbapenemases OXA-48 and KPC-3 were constructed. MIC determinations and time–kill assays were performed for imipenem, meropenem and ertapenem alone or in combination with DMSA. Infected mice were treated intraperitoneally for 24 h with imipenem, DMSA or their combination. Bacterial counts in peritoneal fluid and spleen were assessed at 24 h. Results DMSA in combination with each carbapenem caused a significant decrease in the MICs for all MBL-producing strains, in a concentration-dependent manner, but did not provide benefit against non-MBL strains. In mice infected with the NDM-1-producing strain, the combination of imipenem and DMSA significantly reduced bacterial counts in peritoneal fluid (P = 0.0006) and spleen (P < 0.0001), as compared with imipenem alone, with no benefit against the KPC-3-producing and CFT073 strains. DMSA concentrations in plasma of mice were comparable to those obtained in humans with a standard oral dose. Conclusions DMSA restores the activity of carbapenems against MBL-producing strains, and its combination with carbapenems appears to be a promising strategy for the treatment of NDM-producing E. coli infections.

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Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance

Cited by 10 publications

References 39 publications

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities

Dimercaptosuccinic acid in combination with carbapenems against isogenic strains of Escherichia coli producing or not producing a metallo-β-lactamase in vitro and in murine peritonitis

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