Efficacy and safety of carbapenems versus new antibiotics for treatment of adult patients with complicated urinary tract infections: A systematic review and meta-analysis

Abstract This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs) with the comparators being new antibiotics evaluated for this indication. We searched 13 electronical databases for published randomised controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed by using the PICOS framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favour the new antibiotic groups, although this is not statistically significant [risk ratio (RR)=0.91; 95% confidence interval (CI); 0.79-1.04]. A pooled estimate examining clinical response alone showed no difference between treatment arms (RR=1.00; 95% CI: 0.96-1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR=0.85; 95% CI: 0.79-0.91). New antibiotic treatments demonstrated a superior microbiological response compared to carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from carbapenems.

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1460. The Effectiveness of Short vs. Long Antibiotic Therapy in Hospitalized Adult Patients with Urinary Tract Infections: A Systematic Review and Meta-Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1324 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S533-S534

Author(s):

Tala Ballouz ◽

Nesrine Rizk

Keyword(s):

Systematic Review ◽

Drug Resistance ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Clinical Success ◽

Meta Analysis ◽

Adult Patients ◽

Multi Drug Resistance ◽

Trial Quality ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are a frequent cause of morbidity and mortality in hospitalized patients, if not adequately and promptly treated. The optimal treatment duration is controversial and most recommendations are based on clinical experience. Current guidelines recommend 5–14 days of treatment depending on the type and severity of infection and the antibiotic used. With the emergence of multi-drug resistance, shorter durations are increasingly favored. This systematic review of randomized controlled trials (RCTs) aims at providing updated evidence on the effectiveness of short (≤7 days) vs. long (>7 days) antibiotic regimens in hospitalized adult patients. Methods MEDLINE, EMBASE, and CENTRAL were searched to identify relevant RCTs. Trial quality was evaluated using Cochrane’s Risk of Bias Tool. The primary outcome was clinical success. Secondary outcomes included microbiological success, withdrawal due to adverse events (AE), relapse, and reinfection rates. A random-effect meta-analysis was performed using R. Results 8 RCTs conducted between 1995 and 2018 were identified. Trial quality was considered poor in 5, fair in 1 and good in 2 RCTs. Clinical and microbiological success was reported in all studies. Withdrawal due to AE was reported in 5, relapse and reinfection in 3 studies. Overall, there was no difference in clinical success between short and long courses (OR = 0.92, 95% CI 0.66–1.29; 2111 patients) (figure). Similarly, microbiological success was comparable in the two arms (OR = 1.0, 95% CI 0.70–1.43; 2111 patients). There was a higher, but nonsignificant, number of withdrawals due to AE in the long duration arm (OR = 0.78, 95% CI 0.29–2.11; 1890 patients). Patients receiving short courses had a nonsignificant higher rate of relapse (OR = 2.65, 95% CI 0.31–22.39, 175 patients). However, there was no difference in reinfection rates (OR = 1.12, 95% CI 0.26–4.90; 175 patients). A subgroup analysis limited to complicated UTIs showed similar results. Conclusion Based on the limited available evidence, short antibiotic courses appear to be equally effective as longer courses in the management of inpatient UTIs. Further research is needed to determine appropriate antibiotic treatment durations and assess treatment-related development of drug resistance. Disclosures All authors: No reported disclosures.

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