Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant <i>Escherichia coli</i>

Abstract

Background/Aims:Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli.Methods:We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN.Results:Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319).Conclusions:Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies

“…UPEC strains are also susceptible to ciprofloxacin (Tosun et al, 2016 ), cefotaxime, piperacillin/tazobactam (Dizbay et al, 2016 ), azithromycin, doxycycline and ceftriaxone (Saha et al, 2015 ). However, several UPEC isolates are resistant to ampicillin, oral first-generation cephalosporins, TMP-sulfamethoxazole (Moya-Dionisio et al, 2016 ), cefuroxime (Chang et al, 2016 ), cotrimoxazole (Saha et al, 2015 ), amoxicillin-clavulanate, nalidixic acid, cefradine, and aminopenicillins (Narchi and Al-Hamdani, 2010 ). In some cases, the combined effect of different antibiotics prompted a significant increment in susceptibility, as found for triclosan with amoxicillin and gentamicin (Wignall et al, 2008 ).…”

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

“…Considering the results of a domestic study involving outpatients [ 98 ], fluoroquinolones may be used, but they should be replaced later with appropriate antibiotics based on antibiotic susceptibility test results. In a domestic retrospective study, early empirical administration of cefuroxime resulted in a significantly high early clinical cure rate in the cefuroxime-susceptible group compared with the cefuroxime-resistant group (90.8% vs. 68.2%, p = 0.001) [ 107 ]. However, there was no significant difference in the clinical cure rate (97.8% vs. 88.2%, p = 0.078) or the microbiological cure rate (93.4% vs. 90.8%) in a later follow-up [ 107 ].…”

“…In a domestic retrospective study, early empirical administration of cefuroxime resulted in a significantly high early clinical cure rate in the cefuroxime-susceptible group compared with the cefuroxime-resistant group (90.8% vs. 68.2%, p = 0.001) [ 107 ]. However, there was no significant difference in the clinical cure rate (97.8% vs. 88.2%, p = 0.078) or the microbiological cure rate (93.4% vs. 90.8%) in a later follow-up [ 107 ]. In a retrospective study comparing cefuroxime and cefotaxime, the clinical effects of cefuroxime were on a par with those of cefotaxime [ 108 ].…”

Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers

“…Our findings could explain this difference in mortality. However, a retrospective study from South Korea found effect of cefuroxime 750 mg q8h in patients with complicated urinary tract infections caused by E. coli [16]. The beneficial response to this rather low dose of cefuroxime in these cases may be related to the high cefuroxime concentrations achieved in urine, which explain the effect of renally excreted antibiotics in treatment of urinary tract infection.…”