title: Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, and Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000583:Amikacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D014556:Urine / Q000382:microbiology; D065093:beta-Lactamase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D065093:beta-Lactamase Inhibitors; D000583:Amikacin; D001618:beta-Lactamases
keywords: Amikacin; Beta-lactamases; Outpatients; Urinary tract infections