title: Ertapenem in outpatient parenteral antimicrobial therapy for complicated urinary tract infections.
abstract: BACKGROUND
  Ertapenem is a broad-spectrum antibiotic that is increasingly being utilized. Its dosing convenience renders it suitable for outpatient therapy, and its pharmacokinetic characteristics favour its use against complicated urinary tract infections (cUTIs). Despite this, sufficient clinical data are lacking for its use against cUTIs in the outpatient setting. We assessed the microbiological and clinical cure rates associated with ertapenem treatment for cUTIs in two outpatient parenteral antimicrobial therapy (OPAT) departments.
  
  
  METHODS
  We undertook a prospective observational study of adult patients who received ertapenem for cUTIs between August 2010 and August 2014. Data on patient characteristics, clinical progress and microbiological results were collected and analysed.
  
  
  RESULTS
  Sixty-one patients were enrolled. The median age was 59 years (range 24, 83) and 61% were male. The most common diagnoses were pyelonephritis (39%) and prostatitis (15%). The most common causative organism was Escherichia coli (67%). Extended-spectrum β-lactamase (ESBL)-producing organisms were detected in 72% of infections. Microbiological cure was achieved in 67% overall, and was less likely in those with Klebsiella pneumoniae infection (OR = 0.21 [95%CI: 0.05 to 0.85] p = 0.029). Clinical cure was observed in 92% of patients.
  
  
  CONCLUSIONS
  In this study of treating cUTIs with ertapenem, we have demonstrated good clinical outcomes. A lower than expected microbiological cure rate was observed in those with Klebsiella pneumoniae infection.
authors.affiliation: a Division of Infectious Diseases , University Medicine Cluster, National University Hospital , Singapore , Singapore.|b Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.
authors.forename: Mohamad-Ali
authors.initials: MA
authors.lastname: Trad
authors.affiliation: d Outpatient Parenteral Antibiotic Therapy Clinic , Tan Tock Seng Hospital , Singapore , Singapore.
authors.forename: Lihua H
authors.initials: LH
authors.lastname: Zhong
authors.affiliation: c Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Llorin
authors.affiliation: a Division of Infectious Diseases , University Medicine Cluster, National University Hospital , Singapore , Singapore.
authors.forename: Shire Yang
authors.initials: SY
authors.lastname: Tan
authors.affiliation: c Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore.
authors.forename: Monica
authors.initials: M
authors.lastname: Chan
authors.affiliation: a Division of Infectious Diseases , University Medicine Cluster, National University Hospital , Singapore , Singapore.
authors.forename: Sophia
authors.initials: S
authors.lastname: Archuleta
authors.affiliation: a Division of Infectious Diseases , University Medicine Cluster, National University Hospital , Singapore , Singapore.
authors.forename: Zuraidah
authors.initials: Z
authors.lastname: Sulaiman
authors.affiliation: e Department of Clinical Sciences and Administration , University of Houston College of Pharmacy , Houston , TX , USA.
authors.forename: Vincent H
authors.initials: VH
authors.lastname: Tam
authors.affiliation: b Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.|c Institute of Infectious Diseases and Epidemiology , Tan Tock Seng Hospital , Singapore , Singapore.
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
authors.affiliation: a Division of Infectious Diseases , University Medicine Cluster, National University Hospital , Singapore , Singapore.|b Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.
authors.forename: Dale A
authors.initials: DA
authors.lastname: Fisher
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000077727:Ertapenem; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy*; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077727:Ertapenem
keywords: Complicated urinary tract infections (cUTIs); Ertapenem; Multi-drug-resistant organisms; Outpatient parenteral antimicrobial therapy