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Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections

BACKGROUND: Extended-spectrum β-lactamase (ESBL)–producing Enterobacterales are frequent causes of urinary tract infections (UTIs). Severe infections caused by ESBL Enterobacterales are often treated with carbapenems, but optimal treatment for less severe infections such as UTIs is unclear. METHODS:...

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Autores principales: Anderson, Daniel T, Albrecht, Benjamin, Jones, K Ashley, Jacob, Jesse T, Sexton, Mary Elizabeth, Wiley, Zanthia, Dube, William C, Lee, Benjamin, Suchindran, Sujit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843075/
https://www.ncbi.nlm.nih.gov/pubmed/35174254
http://dx.doi.org/10.1093/ofid/ofac034
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author Anderson, Daniel T
Albrecht, Benjamin
Jones, K Ashley
Jacob, Jesse T
Sexton, Mary Elizabeth
Wiley, Zanthia
Dube, William C
Lee, Benjamin
Suchindran, Sujit
author_facet Anderson, Daniel T
Albrecht, Benjamin
Jones, K Ashley
Jacob, Jesse T
Sexton, Mary Elizabeth
Wiley, Zanthia
Dube, William C
Lee, Benjamin
Suchindran, Sujit
author_sort Anderson, Daniel T
collection PubMed
description BACKGROUND: Extended-spectrum β-lactamase (ESBL)–producing Enterobacterales are frequent causes of urinary tract infections (UTIs). Severe infections caused by ESBL Enterobacterales are often treated with carbapenems, but optimal treatment for less severe infections such as UTIs is unclear. METHODS: This retrospective cohort study included patients admitted to 4 hospitals in an academic healthcare system with an ESBL UTI treated with either a noncarbapenem β-lactam (NCBL) or a carbapenem for at least 48 hours from 1 April 2014 to 30 April 2018. Those who received an NCBL were compared to those receiving a carbapenem, with a primary outcome of hospital length of stay (LOS) and secondary outcomes of clinical and microbiological response, days until transition to oral therapy, rate of relapsed infection, and rate of secondary infections with a multidrug-resistant organism. RESULTS: Characteristics were similar among patients who received carbapenems (n = 321) and NCBLs (n = 171). There was no difference in LOS for the NCBL group compared to the carbapenem group (13 days vs 15 days, P = .66). The NCBL group had higher rates of microbiologic eradication (98% vs 92%, P = .002), shorter time to transition to oral therapy (5 days vs 9 days, P < .001), shorter overall durations of therapy (7 days vs 10 days, P < .001), and lower rates of relapsed infections (5% vs 42%, P = .0003). CONCLUSIONS: Patients treated with NCBLs had similar LOS, higher rates of culture clearance, and shorter durations of antibiotic therapy compared to patients treated with carbapenems, suggesting that treatment for ESBL UTIs should not be selected solely based on phenotypic resistance.
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spelling pubmed-88430752022-02-15 Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections Anderson, Daniel T Albrecht, Benjamin Jones, K Ashley Jacob, Jesse T Sexton, Mary Elizabeth Wiley, Zanthia Dube, William C Lee, Benjamin Suchindran, Sujit Open Forum Infect Dis Major Article BACKGROUND: Extended-spectrum β-lactamase (ESBL)–producing Enterobacterales are frequent causes of urinary tract infections (UTIs). Severe infections caused by ESBL Enterobacterales are often treated with carbapenems, but optimal treatment for less severe infections such as UTIs is unclear. METHODS: This retrospective cohort study included patients admitted to 4 hospitals in an academic healthcare system with an ESBL UTI treated with either a noncarbapenem β-lactam (NCBL) or a carbapenem for at least 48 hours from 1 April 2014 to 30 April 2018. Those who received an NCBL were compared to those receiving a carbapenem, with a primary outcome of hospital length of stay (LOS) and secondary outcomes of clinical and microbiological response, days until transition to oral therapy, rate of relapsed infection, and rate of secondary infections with a multidrug-resistant organism. RESULTS: Characteristics were similar among patients who received carbapenems (n = 321) and NCBLs (n = 171). There was no difference in LOS for the NCBL group compared to the carbapenem group (13 days vs 15 days, P = .66). The NCBL group had higher rates of microbiologic eradication (98% vs 92%, P = .002), shorter time to transition to oral therapy (5 days vs 9 days, P < .001), shorter overall durations of therapy (7 days vs 10 days, P < .001), and lower rates of relapsed infections (5% vs 42%, P = .0003). CONCLUSIONS: Patients treated with NCBLs had similar LOS, higher rates of culture clearance, and shorter durations of antibiotic therapy compared to patients treated with carbapenems, suggesting that treatment for ESBL UTIs should not be selected solely based on phenotypic resistance. Oxford University Press 2022-02-14 /pmc/articles/PMC8843075/ /pubmed/35174254 http://dx.doi.org/10.1093/ofid/ofac034 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Anderson, Daniel T
Albrecht, Benjamin
Jones, K Ashley
Jacob, Jesse T
Sexton, Mary Elizabeth
Wiley, Zanthia
Dube, William C
Lee, Benjamin
Suchindran, Sujit
Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title_full Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title_fullStr Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title_full_unstemmed Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title_short Efficacy of Noncarbapenem β-Lactams Compared to Carbapenems for Extended-Spectrum β-Lactamase–Producing Enterobacterales Urinary Tract Infections
title_sort efficacy of noncarbapenem β-lactams compared to carbapenems for extended-spectrum β-lactamase–producing enterobacterales urinary tract infections
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843075/
https://www.ncbi.nlm.nih.gov/pubmed/35174254
http://dx.doi.org/10.1093/ofid/ofac034
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