The efficacy of non-carbapenem antibiotics for the treatment of community-onset acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli.

Abstract

OBJECTIVE:

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has become an important cause of community-onset urinary tract infections. We aimed to evaluate the efficacy of non-carbapenem antibiotics for acute pyelonephritis (APN) due to ESBL-producing E. coli.

METHODS:

We conducted a retrospective cohort study of patients with community-onset APN due to ESBL-producing E. coli at a single centre in Korea from 2007 to 2013. Outcomes included both microbiological and clinical failure. To adjust for non-random assignment of antibiotics, the propensity score method of inverse probability of treatment weighting and a multivariable analysis using Cox proportional hazards modelling were employed to estimate the efficacy of non-carbapenem antibiotics as compared with carbapenems.

RESULTS:

Of 152 eligible patients, 85 (55.9%) received carbapenems and 67 (44.1%) received non-carbapenems. Non-carbapenem antibiotics used in this cohort included aminoglycosides (n = 30), β-lactam/β-lactamase inhibitors (n = 13), fluoroquinolones (n = 12) and trimethoprim/sulfamethoxazole (n = 5). Microbiological failure was observed in 16 patients receiving carbapenems (16/83, 19.3%) versus 4 patients receiving non-carbapenem (4/67, 6.0%). After weighting, the risk of microbiological failure was similar between the two groups [weighted hazard ratio (HR) 0.99; 95% CI 0.31-3.19]. In a multivariable regression analysis combined with weights, the estimate did not change (weighted adjusted HR 0.96; 95% CI 0.41-2.27). The clinical failure rate was also similar in the two groups (weighted HR 1.05; 95% CI 0.24-4.62).

CONCLUSIONS:

These results suggest that non-carbapenem antibiotics were as effective as carbapenems as definitive therapy for treating community-onset APN caused by ESBL-producing E. coli if they are active in vitro.

• Authors: Sun Hee Park, Su-Mi Choi, Yoon Kyung Chang, Dong-Gun Lee, Sung-Yeon Cho, Hyo-Jin Lee, Jung-Hyun Choi, Jin-Hong Yoo
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 69 Issue 10 Pg. 2848-56 (Oct 2014) ISSN: 1460-2091 [Electronic] England
• PMID: 24928854 (Publication Type: Journal Article)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents
• beta-Lactamases

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Child
• Child, Preschool
• Community-Acquired Infections
• Comorbidity
• Drug Resistance, Bacterial (genetics)
• Escherichia coli (drug effects, genetics)
• Escherichia coli Infections (diagnosis, drug therapy, microbiology, mortality)
• Female
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Pyelonephritis (drug therapy, microbiology)
• Retrospective Studies
• Risk Factors
• Treatment Failure
• Treatment Outcome
• Young Adult
• beta-Lactamases (genetics)