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

• Type of Material: Article
• Authors: Daniel T. Anderson, Emory Healthcare; Benjamin Albrecht, Emory Healthcare; K. Ashley Jones, Emory Healthcare; Jesse Jacob, Emory University; Marybeth Sexton, Emory University; Zanthia Wiley, Emory University; William C. Dube, Emory University; Benjamin Lee, Emory University; Sujit Suchindran, Emory University
• Language: English
• Date: 2022-03-01
• Publisher: Oxford University Press Inc.
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofac034
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• Volume: 9
• Issue: 3
• Start Page: ofac034
• End Page: ofac034
• Grant/Funding Information: None declared
• Keywords: Bacteremia; Immunology; Life Sciences & Biomedicine; ESBL; Science & Technology; urinary tract infection; Inhibitor development; Microbiology; Evolution; Infectious Diseases; Klebsiella pneumonia; extended-spectrum beta-lactamase; Mortality; Piperacillin; Blood stream infections; antimicrobial resistance; Escherichia coli; antimicrobial stewardship; Resistance
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology; Biology, Microbiology

Abstract

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.