title: Outcomes of Aminopenicillin Therapy for Vancomycin-Resistant Enterococcal Urinary Tract Infections.
abstract: Vancomycin-resistant urinary tract infections are often challenging to treat. This retrospective cohort study compared outcomes between patients treated for vancomycin-resistant enterococcal urinary tract infection with an aminopenicillin and those treated with a non-β-lactam antibiotic. Inpatients treated with an enterococcus-active agent for their first symptomatic vancomycin-resistant enterococcal urinary tract infection between 1 January 2012 and 31 December 2013 were considered for inclusion. Patients with colonization, on hospice, or receiving comfort care only were excluded. The primary endpoint of clinical cure was defined as resolution of clinical symptoms, or symptom improvement to the extent that no additional antibacterial drug therapy was necessary, and lack of microbiologic persistence. Secondary endpoints of 30-day readmission or retreatment and 30-day all-cause mortality were also compared. A total of 316 urinary isolates were screened, and 61 patients with symptomatic urinary tract infection were included. Twenty (35%) of the 57 isolates tested were ampicillin susceptible. Thirty-one patients received an aminopenicillin, and 30 received a non-β-lactam. Rates of clinical cure for aminopenicillin versus non-β-lactam treatment were 26/31 (83.9%) and 22/30 (73.3%) (P = 0.315), respectively. Rates of 30-day readmission (6/31, or 19.4%, versus 9/30, or 30%, respectively; P = 0.334), 30-day retreatment (4/31, or 12.9%, versus 4/30, 13.3%, respectively; P = 0.960), and 30-day all-cause mortality (2/31, or 6.5%, versus 1/30, or 3.3%, respectively; P = 0.573) were also not significantly different between groups. Aminopenicillins may be a viable option for treating vancomycin-resistant urinary tract infection regardless of the organism's ampicillin susceptibility. Prospective validation with larger cohorts of patients should be considered.
authors.affiliation: Department of Pharmacy Services, University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Kelli A
authors.initials: KA
authors.lastname: Cole
authors.affiliation: Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA rkenney1@hfhs.org.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kenney
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Perri
authors.affiliation: Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, Michigan, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Dumkow
authors.affiliation: Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Linoj P
authors.initials: LP
authors.lastname: Samuel
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan, USA Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Zervos
authors.affiliation: Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016983:Enterococcus / Q000187:drug effects / Q000472:pathogenicity; D016984:Enterococcus faecium / Q000187:drug effects / Q000472:pathogenicity; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D020713:Vancomycin Resistance / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D000658:Amoxicillin