Treating ESBL-EC UTIs in an outpatient intravenous therapy setting

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Abstract:

BACKGROUND/AIMS: The number of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem.

METHODS: We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC.

RESULTS: From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity.

CONCLUSIONS: Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources.

Reference:

Cho, S.Y., Choi, S.M., Park, S.H., Lee, D.G., Choi, J.H. and Yoo, J.H. (2016) Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli. The Korean Journal of Internal Medicine. 31(1), p.156-61.

DOI: 10.3904/kjim.2016.31.1.156.

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