title: Non-carbapenem therapy of urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae.
abstract: OBJECTIVE
  We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems.
  
  
  METHODS
  The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months.
  
  
  RESULTS
  Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia.
  
  
  CONCLUSIONS
  Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients.
authors.affiliation: Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: delablanchardiere-a@chu-caen.fr.
authors.forename: A
authors.initials: A
authors.lastname: de La Blanchardière
authors.affiliation: Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Dargère
authors.affiliation: Service de microbiologie, CHU de Caen, Caen, France.
authors.forename: F
authors.initials: F
authors.lastname: Guérin
authors.affiliation: Service de microbiologie, CHU de Caen, Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Daurel
authors.affiliation: Service de pharmacie, CHU de Caen, Caen, France.
authors.forename: G
authors.initials: G
authors.lastname: Saint-Lorant
authors.affiliation: Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Verdon
authors.affiliation: Service de microbiologie, CHU de Caen, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000502:physiology*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D002442:Ceftazidime / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D015995:Prevalence; D011472:Prostatitis / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D024841:Fluoroquinolones; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D002442:Ceftazidime; D001618:beta-Lactamases; D010878:Piperacillin
keywords: ESBL Enterobacteriaceae; Entérobactéries BLSE; Infection urinaire; Piperacillin-tazobactam; Pipéracilline-tazobactam; Urinary tract infection