Filiz YILDIRIM, KADRİYE KART YAŞAR, Gönül ŞENGÖZ, Semra SANDOKÇI, Özcan NAZLICAN

Ertapenem: Komplike üriner sistem enfeksiyonları için yeni bir antibiyotik seçeneği

Giriş: Komplike üriner sistem enfeksiyonlarının (ÜSE) tedavisi, eğer etken mikroorganizma genişlemiş spektrumlu [3 laktamaz (GSBL) salgılıyorsa, güçlü antimikrobiyallerle parenteral tedaviyi gerekli kılar. Bu çalışmada, yeni bir karbapenem olan ertapenemin komplike ve non-komplike üriner enfeksiyöz patojenlere karşı etkililiği araştırıldı. Gereç ve Yöntem: Hastanemiz Mikrobiyoloji Laboratuvarında 2009 yılının ilk 3 ayında üriner sistem enfeksiyonu etkeni olarak izole edilen 256 suş incelendi. Suşların yarısı komplike, diğer yarısı ise non-komplike üriner infeksiyonlu hastalara aitti. Konvansiyonel yöntemlerle identifiye edilen bakterilerin antibiyotik duyarlılıkları CLSI önerileri doğrultusunda disk difüzyon yöntemiyle araştırıldı. Bulgular: Her iki grupta en sık izole edilen bakteri Escherichia coli olmuştur (sırasıyla 91 ve 92 adet). En fazla GSBL saptanan bakteriler Klebsiella pneumoniae ve E. coli olarak bulundu. Komplike ve non-komplike ÜSE etkenlerindeki GSBL oranları sırasıyla E. coli için %25, %15 ve K. pneumoniae için %53, %14 olarak saptandı. İncelenen antibiyotikler açısından (amoksisilin-klavulanik asit, amikasin, seftriakson, siprofloksasin, sefaperazon-sulbaktam, imipenem, piperasilin-tazobaktam) direnç oranları komplike ÜSE etkenlerinde daha yüksek bulunduğu halde ertapenem direnci, her iki grup için de düşük ve benzer oranlarda saptandı. Sonuç: Ertapenem; GSBL salgılayan bakterilere etkili, geniş spektrumlu, günde tek doz kullanılan yeni bir karbapenemdir. Komplike ÜSE olan olgularda düşük direnç oranları nedeni ile yeni bir tedavi seçeneği oluşturmaktadır.

Anahtar Kelimeler:

İdrar yolu enfeksiyonları, ertapenem, İlaç direnci, bakteriyel, Mikrobiyal duyarlılık testleri, Anti-bakteriyel ajanlar

Ertapenem: A new antibiotic choice for complicated urinary tract infections

Objective: The treatment of complicated urinary tract infections (UTIs) may require the use of a parenteral antimicrobial agent active against the extended spectrum |3 lactamases-producing urinary pathogens. The activity of ertapenem, a new once-a-day carbapenem, was investigated in pathogens isolated from complicated and non-complicated UTIs. Material and method: A total of 256 urinary pathogen were studied. The half of the strains were isolated from complicated and the others were from non-complicated UTIs within three months in our laboratory. The antimicrobial susceptibilities of all strains identified by conventional laboratory methods were investigated using the disc diffusion method following the reccomendations of CLSI. Results: The most common pathogen was E. coli in each two group (respectively 91 and 92 strains). Klebsiella pneumoniae and E. coli were the most common ESBL-producing bacteria. ESBL rates in two groups for E. coli and Klebsiella pneumoniae were 25%, 15% and 53%, 14% respectively. While the resistance rates in complicated UTIs pathogens were higher than non-complicated UTIs pathogens for several antibiotics (amoxycillin-clavulanate, amikacin, ceftriaxone, ciprofloxacin, cephoperazon-sulbactam, imipenem, piperacillin-tazobactam), the ertapenem resistance was low in two groups. Conclusion: Ertapenem, a new once-a-day, broad spectrum carbapenem which is highly effective on ESBL-producing bacteria, is a good alternative choisefor the treatment .of complicated UTIs due to low resistance rates.

Keywords:

Urinary Tract Infections, ertapenem, Drug Resistance, Bacterial, Microbial Sensitivity Tests, Anti-Bacterial Agents,

PDF

___

1.Wexler HM. In vitro activity of ertapenem: review of recent studies. Journal of Antimicrobial Chemotherapy, 2004; 53: H11-U21 2.Tomera KM, Burdmann AE, Pamo Reyna OG, Jiang Q, Wimmer WM, Woods GL, Gesser RM, Protocol 014 Study Group. Ertapenem versus ceftriaxone followed by apropriate oral therapy for treatment of complicated urinary tract infections in adults: Result of of a prospective, randomized, double-blind multicenter study. Antimicrobial Agents and Chemotherapy, 2002; Sept: 2895-2900 3.Wells WG, Woods GL, Jiang O, Gesser RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother, 2004; 53, Suppl. S2, U67-U74 4.Nix DE, Majumdar AK, DiNubile MJ. Pharmacokinetics and pharmacodynamics of ertapenem: an overview for clinicians. J Antimicrob Chemother , 2004; 53 Suppl. S2: U23-İİ28 5.Arguedas A, Cespedes J, Botet AF, Blumer J, Yogev R, Gesser R, Wang J, West J, Snyder T, Wimmer W, for THA Protocol 036 Study Group. Safety and tolerability of ertapenem versus ceftriaxone in a double-blind study performed in children with complicated urinary tract infection, community-acquired pneumonia or skin and soft-tissue infection. International Journal of Antimicrobial Agents, '2009; 33: 163-167 6.Koksal F, Ak K, Kucukbasmaci O, Samasti M. Prevalence and antimicrobial resistance patterns of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in an Istanbul University Hospital. Chemotherapy, 2009; 55(4): 293-297 7.Hosoglu S, Gundes S, Kolaylı F, Karadenizli A, Demirdağ K, Günaydın M, Altındiş M, Çayları R, Uçmak H. Extended spectrum beta lactamases in ceftazidime resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish Hospitals. Indian Journal of Medical Microbiology, 2007; 25(4): 346-350 8.Tamayo J, Orden B, Cacho J, Cuadros J, Gomez-Garces JL, Alos JI. Activity of ertapenem and other antimicrobials againts ESBL-producing enterobacteria isolated from urine in patients from Madrid. Rev Esp Quimioterap, 2007; 20: 334-338
9.Alhambra A, Cuadros JA, Cacho J, Gomez-Garces JL, Alos JI. In vitro susceptibility of recent antibiotic-resistant urinary pathogens to ertapenem and 12 other antibiotics.J Antimicrob Chemother, 2004; 53: 1090-1094 10.Teng CP, Chen HH, Chan J, Lye DC. Ertapenem for the treatment of extended- spectrum beta-lactamase-producing Gram-negative bacterial infections. Int J of Antimicrob Agents, 2007; 30: 356-359 11.Lye DC, Wijaya L, Chan J, Teng CP, Leo YS. Ertapenem for treatment of extended-spectrum beta-lactamase-producing and multidrug-resistant Gram-negative bacteraemia. Ann Acad Med Singapore, 2008; 37: 831-834 12.Livermore DM, Oakton KJ, Carter MW, Warner M. Activity of ertapenem (MK-0826) versus Enterobacteriaceae with potent (3-lactamases. Antimicrobial Agents and Chemotherapy, 2001; Oct: 2831-2837