title: Efficacy of empirical therapy with non-carbapenems for urinary tract infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae.
abstract: OBJECTIVE
  Carbapenems are first-line agents for severe infections with extended-spectrum beta-lactamase (ESBL)-producing bacteria. The use of carbapenems, however, is associated with the emergence of resistant organisms. We investigated the effects of empirical therapy with non-carbapenems on urinary tract infections (UTIs) with ESBL-producing Enterobacteriaceae in a hospital where antimicrobial stewardship has been established.
  
  
  METHODS
  This retrospective chart review was undertaken at a tertiary care hospital where antimicrobial stewardship and restriction of carbapenems has been established. Patients with a UTI with ESBL-producing Enterobacteriaceae were stratified into susceptible and non-susceptible therapy groups according to the susceptibility of the causative organism to the initial antimicrobial therapy. Outcome measures were the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, and clinical cure.
  
  
  RESULTS
  Of 90 patients, 30 (33.3%) exhibited susceptible therapy. However, no significant difference was observed in the duration of antimicrobial therapy, 14-day mortality, infection-related mortality, or clinical cure between the susceptible and non-susceptible groups. Multivariate analyses revealed that the independent risk factor for 14-day morality was the use of immunosuppressive agents (odds ratio 5.23, 95% confidence interval 1.26-24.04; p=0.023).
  
  
  CONCLUSIONS
  Non-carbapenem therapy against UTIs with ESBL-producing Enterobacteriaceae does not pose a significant risk to patients who are not taking immunosuppressive agents.
authors.affiliation: Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: takanori.asakura@gmail.com.
authors.forename: Takanori
authors.initials: T
authors.lastname: Asakura
authors.affiliation: Department of Medical Informatics, Kagawa University Hospital, Mikicho, Kagawa, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Asahi General Hospital, Asahi, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kodera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D007166:Immunosuppressive Agents; D001618:beta-Lactamases
keywords: Beta-lactamases; Carbapenems; Cefmetazole; Cephamycins; Urinary tract infections