Abstract
BackgroundDue to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. We conducted a prospective, randomized, open-label comparison of the therapeutic efficacy of piperacillin-tazobactam (PTZ), cefepime, and ertapenem in febrile nosocomial urinary tract infection with ESBL-producing Escherichia coli (ESBL-EC).MethodsThis study was conducted at three university hospitals between January 2013 and August 2015. Hospitalized adult patients presenting with fever were screened for healthcare-associated urinary tract infection (HA-UTI). When ESBL-EC was solely detected and susceptible to a randomized antibiotic in vitro, the case was included in the final analysis. Participants were treated for 10–14 days with PTZ, cefepime, or ertapenem.ResultsA total of 66 participants were evenly assigned to the PTZ and ertapenem treatment groups. After the recruitment of six participants, assignment to the cefepime treatment group was stopped because of an unexpectedly high treatment failure rate. The baseline characteristics of these participants did not differ from participants in other treatment groups. The clinical and microbiological response to PTZ treatment was estimated to be 94% and was similar to the response to ertapenem treatment. The efficacy of cefepime was 33.3%. In the cefepime group, age, Charlson comorbidity index, genotype, and minimal inhibitory concentration (MIC) did not significantly affect the success of treatment. Similarly, genotype seemed to be irrelevant with respect to clinical outcome in the PTZ group. Expired cases tended to involve septic shock with a high Charlson comorbidity index and high MIC.ConclusionResults from this study suggest that PTZ is effective in the treatment of urinary tract infection caused by ESBL-EC when the in vitro test indicates susceptibility. In addition, cefepime should not be used as an alternative treatment for urinary tract infection caused by ESBL-EC.Trial registrationThe trial was registered with the Clinical Research Information Service of Korea Centers for Disease Control and Prevention. (KCT0001895)
Highlights
Due to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern
There were more female than male participants assigned to both the PTZ and ertapenem treatment groups, but significant gender differences were not observed between the two groups (p = 0.303)
The sample size was small, results from the study showed that PTZ was as effective as ertapenem for the treatment of ESBL-producing Escherichia coli (ESBL-EC) urinary tract infection (UTI)
Summary
Due to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. The spread of extended-spectrum beta-lactamase (ESBL)producing organisms has gradually increased in hospitals and long-term care facilities [1]. The spread of ESBLs has become a major public health concern due to limited therapeutic options. Carbapenems are generally considered the drug of choice for ESBL-producing organism infections due to their stability against ESBLs [5, 6]. Their use should be restricted considering the emergence of carbapenem-resistant organisms [7]. Over the past few decades, numerous studies have been conducted to determine possible alternatives
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