title: Treatment efficacy and superinfection rates in complicated urinarytract infections treated with ertapenem or piperacillin tazobactam.
abstract: OBJECTIVE
  In this retrospective study, the efficacy of ertapenem and piperacillin tazobactam was compared in the treatment of complicated urinary tract infections (cUTIs). Treatment responses were also evaluated for both antibiotics.
  
  
  METHODS
  A total of 230 patients were enrolled in the study. Of these, 170 received ertapenem and 60 received piperacillin-tazobactam.
  
  
  RESULTS
  In both groups, urine cultures after 48 h were negative for the initial uropathogen. The frequency of superinfection was 29.4% in the ertapenem group and 8.3% in the piperacillin-tazobactam group over the duration of treatment (P < 0.05). Urinary catheterization increased the superinfection risk 2.88-fold in the ertapenem group and diabetes mellitus increased the risk 8.50-fold in the piperacillin-tazobactam group (CI: 1.44-5.76 and 1.16-62.09, respectively, P < 0.05). The main pathogen isolated from superinfection in the ertapenem group after 48 h was Enterococcus spp. (71.4%).
  
  
  CONCLUSIONS
  Both ertapenem and piperacillin-tazobactam were effective in the treatment of cUTIs caused by ESBL-producing microorganisms. A high frequency of superinfection in the ertapenem group was the result of Enterococcus and Pseudomonas spp., against which ertapenem is not active. In the presence of urinary catheterization, diabetes mellitus, and urological intervention, patients should be closely monitored for the development of a superinfection, especially patients receiving ertapenem.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Dizbay
authors.affiliation: Dr. Ersin Arslan Public Hospital, Gaziantep, Turkey.
authors.forename: Hasan Selçuk
authors.initials: HS
authors.lastname: Özger
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Karaşahin
authors.affiliation: Public Health Institution of Turkey, Ankara, Turkey.
authors.forename: Emine Fusun
authors.initials: EF
authors.lastname: Karaşahin
mesh_terms: D000900:Anti-Bacterial Agents; D000077727:Ertapenem; D006801:Humans; D010397:Penicillanic Acid / Q000031:analogs & derivatives; D010878:Piperacillin; D012189:Retrospective Studies; D015163:Superinfection; D000078142:Tazobactam; D016896:Treatment Outcome; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D010397:Penicillanic Acid; D000077727:Ertapenem; D000078142:Tazobactam; D010878:Piperacillin
keywords: Complicated urinary tract infection; efficacy; ertapenem; piperacillin-tazobactam; superinfection