Assessment of Non-Carbapenem Beta-Lactams in the Treatment of Patients with Urinary Tract Infections Caused by Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Open Access

Lee, Benjamin (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/2z10wr46r?locale=en
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Abstract

Background: The widespread use of antibiotics has led to the development of antibiotic resistance, one of the greatest global public health threats currently.  Carbapenems are the treatment of choice for patients with UTIs caused by extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae. However, increased use of carbapenems is associated with the emergence of carbapenem-resistant Enterobacteriaceae.

Objective: To compare the effectiveness of non-carbapenem beta-lactam (NCBL) antibiotics with carbapenem in treating patients with a UTI caused by an ESBL-producing organism. 

Materials and Methods: This was a retrospective cohort study of adult patients admitted to one of four Emory Healthcare hospitals with a diagnosis of UTI caused by an ESBL-producing organism from April 1, 2014 to April 30, 2018. The primary outcome was length of hospital stay. Secondary outcomes included discharge disposition, microbiological eradication, clinical relapse, in-hospital mortality, 30-day readmission rate, rate of C. difficile infection, rate of secondary infection with a new multi-drug organism, number of days to transition to oral therapy, and secondary infection with a carbapenem-resistant organism within 30 days. Regression models were built to determine which variables are predictive of improved or worsened outcomes for patients with UTIs caused by an ESBL-producing organism treated with either NCBL or carbapenem antibiotics.

Results: There were a total of 492 patients included in the analysis (321 patients received carbapenems and 171 received NCBLs). Use of carbapenems was not predictive of shorter hospital stay (OR: 0.99, CI: 0.98-1.00) or lower mortality rate (OR: 1.00, CI: 0.94-1.06) when compared with NCBL antibiotics in our multivariant analysis. However, it was associated with a higher likelihood of clinical relapse (OR: 1.08, CI: 1.02-1.14) and failure to eradicate microorganisms in culture samples (OR: 1.05, CI: 1.01-1.10).

Conclusions: Treatment of UTI patients caused by ESBL producers with NCBL antibiotics result in similar mortality and length of hospital stay when compared to treatment with carbapenems. NCBL antibiotics appear to be an alternative to carbapenems in treating those patients; however, differences in intermediate outcomes (e.g., disease relapse, microorganism eradication) need further study to understand their clinical importance.

Table of Contents

Abstract..........................1-2

Background.....................3-5

Introduction....................6

Materials and Methods.....7-9

Results............................10-13

Discussion.......................14-16

Conclusion......................17

References.......................18-20

Figures and Tables...........21-30

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