Shortening duration of ertapenem in outpatient parenteral antimicrobial therapy for complicated urinary tract infections: A retrospective study.

Doug L Fink,Ronnie Barret,Gabriele Pollara,Michael Marks,Steven Collins,Sarah Logan

doi:10.1371/journal.pone.0223130

Abstract

BackgroundThe incidence of multi-drug resistant ESBL-associated urinary tract infections (UTIs) is increasing globally. Patients with abnormal renal tract anatomy and other co-morbidities are at increased risk of complicated UTI and ESBL-associated infections. The duration and safety of OPAT for this cohort of patients is unknown.ObjectivesThis study aims to provide an evidence base to support decision-making regarding duration of antibiotic treatment for complicated UTIs.MethodsWe retrospectively reviewed all patients receiving ertapenem with or without adjunctive fosfomycin for complicated UTIs in the OPAT service of our tertiary infectious diseases hospital. All data had been collected prospectively as part of routine clinical care. Our primary outcomes were microbiological and clinical cure of UTI.ResultsWe identified 33 treatment episodes of ertapenem use for UTIs. 76% episodes related to pyelonephritis or urosepsis diagnoses. Renal tract abnormalities or prior urological surgery were present in 45% of patients. The median duration of appropriate parenteral antibiotic therapy in our study was 6 days. Clinical cure was achieved with short-course parenteral treatment alone in 81% of patients and this increased to 96% when adjunctive fosfomycin was used. There was a single treatment failure resulting in hospital admission.ConclusionsShort duration ertapenem via OPAT with or without adjunctive fosfomycin is safe and effective for the treatment of complicated UTIs. Further studies are required to inform optimal treatment strategies and publication of guidelines in this field.

Highlights

Antimicrobial resistance (AMR) is associated with increased morbidity, mortality and prolonged hospital admission [1, 2]
We identified 33 treatment episodes of ertapenem use for urinary tract infections (UTIs). 76% episodes related to pyelonephritis or urosepsis diagnoses
Clinical cure was achieved with short-course parenteral treatment alone in 81% of patients and this increased to 96% when adjunctive fosfomycin was used

Summary

Introduction

Antimicrobial resistance (AMR) is associated with increased morbidity, mortality and prolonged hospital admission [1, 2]. Outpatient parenteral antibiotic therapy (OPAT) facilitates the administration of injectable agents to patients outside of hospital who would historically have required prolonged hospital admission. Both patients and health care providers may benefit from shortening in-hospital stays and transferring care into a community or outpatient setting [3]. There is an increasing incidence of community- and hospital-acquired multi-drug resistant extended spectrum beta-lactamase (ESBL)-associated urinary tracts infections (UTIs) [4]. The incidence of multi-drug resistant ESBL-associated urinary tract infections (UTIs) is increasing globally. The duration and safety of OPAT for this cohort of patients is unknown

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