Treatment efficacy and superinfection rates in complicated urinary tract infections treated with ertapenem or piperacillin tazobactam

Treatment efficacy and superinfection rates in complicated urinary tract infections treated with ertapenem or piperacillin tazobactam

Background/aim: 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. Materials and methods: A total of 230 patients were enrolled in the study. Of these, 170 received ertapenem and 60 received piperacillintazobactam.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 piperacillintazobactam 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%). Conclusion: 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.

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  • 1. Bader MS, Hawboldt J, Brooks A. Management of complicated urinary tract infections in the era of antimicrobial resistance. Postgrad Med 2010; 122: 7-15.
  • 2. Hsueh PR, Hoban DJ, Carmeli Y, Chen SY, Desikan S, Alejandria M, Ko WC, Binh TQ. Consensus review of the epidemiology and appropriate antimicrobial therapy of complicated urinary tract infections in Asia-Pacific region. J Infect 2011; 63: 114- 123.
  • 3. Neal DE. Complicated urinary tract infections. Urol Clin N Am 2008; 35: 13-22.
  • 4. Park DW, Peck KR, Chung MH, Lee JS, Park YS, Kim HY, Lee MS, Kim JY, Yeom JS, Kim MJ. Comparison of ertapenem and ceftriaxone therapy for acute pyelonephritis and other complicated urinary tract infections in Korean adults: a randomized, double-blind, multicenter trial. J Korean Med Sci, 2012; 27: 476-483.
  • 5. Tamayo J, Orden B, Cacho J, Cuadros J, Gomes-Gorces JL, Alos JI. Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid. Rev Esp Quimioterap 2007; 20: 334-338.
  • 6. Shah PM, Isaacs RD. Ertapenem, the first of a new group of carbapenems. J Antimicrob Chemother 2003; 52: 538-542.
  • 7. Tomera KM, Burdmann EA, Reyna OGP, Jiang Q, Wimmer WM, Woods GL, Gesser RM; Protocol 014 Study Group. Ertapenem versus ceftriaxone followed by appropriate oral therapy for treatment of complicated urinary tract infections in adults: result of a prospective, randomized, double-blind, multicenter study. Antimicrob Agents Chemother 2002; 46: 2895-2900.
  • 8. Gin A, Dilay L, Karlowsky JA, Walkty A, Rubinstein E, Zhanel GG. Piperacillin-tazobactam: a beta-lactam/beta-lactamase inhibitor combination. Expert Rev Anti Infect Ther 2007; 5: 365-383.
  • 9. Sifuentes-Osornio J, Jakob E, Clara L, Durlach R, Dain A, Ruìz-Palacios GM, Barkan L, Lamberghini R, Jáuregui A, Villalobos Y et al. Piperacillin/tazobactam in the treatment of hospitalized patients with urinary tract infections: an open non-comparative and multi-centered trial. J Chemother 1996; 8: 122-129.
  • 10. Naber KG, Savov O, Salmen HC. Piperacillin 2g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute complicated pyelonephritis and complicated urinary tract infections. Int J Antimicrob Agents 2002; 19: 95-103.
  • 11. Keating GM, Perry CM. Ertapenem: a review of its use in the treatment of bacterial infections. Drugs 2005; 65: 2151-2178.