Ciprofloxacin in the Treatment of Urinary Tract Infections

1987 ◽  
Vol 15 (4) ◽  
pp. 240-244 ◽  
Author(s):  
T. Lotti ◽  
V. Mirone ◽  
C. Imbimbo ◽  
A. Russo
Keyword(s):  
Urinary Tract ◽  
Clinical Response ◽  
Urinary Tract Infections ◽  
Adverse Reactions ◽  
Urinary Calculus ◽  
Complete Disappearance ◽  
Clinical Failure ◽  
Tract Infections

Twenty patients (15 males; five females) aged 11–70 years, with urinary tract infections were treated with one 250 mg tablet of ciprofloxacin every 12 h for 5–10 days. Clinical response to this treatment was the complete disappearance of symptoms in 85% of cases and the elimination of the micro-organism responsible for infection. In only three patients, who all had urinary calculus in addition to an infection, clinical failure of the therapy occurred and the causative micro-organism persisted. Tolerance to the therapy was excellent in this study, no adverse reactions connected with the treatment being reported.

The Clinical Efficacy and Safety of Bacampicillin Twice Daily in Comparative Studies

1987 ◽  
Vol 15 (1) ◽  
pp. 32-43 ◽  
Author(s):  
M. Blomqvist ◽  
S. Å. Hedström
Keyword(s):  
Urinary Tract ◽  
Chronic Bronchitis ◽  
Urinary Tract Infections ◽  
Comparative Studies ◽  
Adverse Reactions ◽  
Low Frequency ◽  
Effective Dosage ◽  
Efficacy And Safety ◽  
Tract Infections ◽  
Dose Levels

In 16 controlled, randomized, comparative studies a total of 953 patients were treated for urinary tract infection, sinusitis, otitis media or chronic bronchitis. The aim was to evaluate the efficacy and safety of bacampicillin in a twice daily dosage, compared with three times daily dosages of bacampicillin, ampicillin, amoxycillin and a twice daily dosage of co-trimoxazole. Bacampicillin was given in amounts of either 400 or 800 mg to 422 of the patients in these studies. The twice daily dosage of bacampicillin eradicated 89% of the causative bacteria of urinary tract infections compared to 86% with the other regimens. In acute sinusitis 92% and 96% of the patients were either cured or improved when treated with 400 and 800 mg bacampicillin twice daily respectively. Similar percentages occurred in the groups given the three times daily dosages. In exacerbation of chronic bronchitis, 800 mg bacampicillin twice daily was the minimum effective dosage and 84% of the patients were either cured or improved with this regimen. Adverse drug reactions due to bacampicillin at all dose levels were less frequent than those of other anti-microbials. The lowest frequency of diarrhoea, 2.4%, was seen in the group given 400 mg bacampicillin twice daily. Dosages of 400 or 800 mg bacampicillin twice daily had a reliable efficacy combined with a low frequency of adverse reactions in respiratory and urinary tract infections.

scholarly journals 1621. Novel Beta-lactam Beta-lactamase Inhibitors Against Alternative Antibiotics for the Treatment of Complicated Urinary Tract Infections and Pyelonephritis Caused by Carbapenem-resistant Enterobacterales

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S803-S803
Author(s):  
Bliss Green ◽  
Jacqueline Meredith ◽  
Renee Ackley ◽  
Maggie S McCarter ◽  
Christopher Polk
Keyword(s):  
Urinary Tract ◽  
Adverse Effects ◽  
Combination Therapy ◽  
Urinary Tract Infections ◽  
Beta Lactamase ◽  
Clinical Failure ◽  
Beta Lactam ◽  
Carbapenem Resistant ◽  
Safety Outcomes ◽  
Tract Infections

Abstract Background There is little data on the comparative efficacy or safety of carbapenem-resistant Enterobacterales (CRE)-targeted beta-lactam beta-lactamase inhibitors (BL-BLI), including ceftazidime/avibactam (CZA) and meropenem/vaborbactam (MVB), versus alternative antibiotics for the treatment of CRE complicated urinary tract infections/acute pyelonephritis (cUTI/AP). The objective of this study was to evaluate rates of clinical failure in patients with CRE cUTI/AP treated with CRE-targeted BL-BLI vs. alternative regimens. Methods This was a multicenter, retrospective cohort study of adults admitted with a CRE cUTI/AP treated with CRE-active antibiotic(s), including combination therapy, for at least 48 hours between January 2012 and June 2019. Exclusion criteria included CRE colonization, non-urinary source co-infection, non-Enterobacterales cUTI/AP, or mortality within 48 hours of index culture. The primary outcome was clinical failure, defined as continued symptoms or recurrence at 30 days from index culture. Secondary outcomes included 90-day recurrence and 30-day readmission. Safety outcomes included treatment-limiting adverse effects, non-treatment limiting nephrotoxicity, and C. difficile infection. Results A total of 47 patients were included (BL-BLI, n=16; alternative, n=31). Alternative regimens contained aminoglycosides, carbapenems, polymyxins, and tigecycline and utilized combination therapy more often (32.3% vs. 6.3%, p=0.046). Clinical failure occurred in 12.5% of patients in the BL-BLI group vs. 38.7% in the alternative group (p=0.063). Higher rates of 90-day recurrence (25.8% vs. 18.8%) and 30-day readmissions (51.6% vs. 31.3%) occurred in the alternative group vs. the BL-BLI group but were not statistically significant (Table 2). There were clinically significant rates of nephrotoxicity in the alternative group (45.2%) compared to the BL-BLI group (18.8%), contributing largely to the difference in treatment-limiting adverse effects (29% vs. 0%, p=0.017). Table 1: Antibiotic Data Table 2: Efficacy Outcomes Table 3: Safety Outcomes Conclusion In this retrospective study, no difference in clinical failure resulted among groups; however, there was significantly more treatment-limiting adverse effects in the alternative group compared to the BL-BLI-based regimens, driven by nephrotoxicity. Disclosures All Authors: No reported disclosures

scholarly journals Outcomes for Community-Acquired Extended-Spectrum Beta-Lactamase (ESBL) Escherichia coli Urinary Tract Infections (UTIs) in Children Treated With Empiric Noncarbapenem Antibiotic Therapy

2020 ◽  
Vol 41 (S1) ◽  
pp. s338-s339
Author(s):  
Jenna Holmen
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Tract Infections ◽  
Medical Condition ◽  
Clinical Failure ◽  
E Coli ◽  
Extended Spectrum ◽  
Tract Infections ◽  
Underlying Medical Condition

Background: Empiric therapy with a cephalosporin antibiotic is the current standard of care for children with urinary tract infections (UTIs). However, as the rate of UTI due to extended-spectrum β-lactamase (ESBL)–producing organisms rises, there is concern that treatment failures may increase. Carbapenems are the most reliable antimicrobials for treating ESBL organisms, but empiric coverage with carbapenems necessitates hospitalization for intravenous therapy. Objective: We evaluated whether empiric noncarbapenem therapy in patients with ESBL Escherichia coli UTI is associated with poorer outcomes. Methods: We conducted a case-control study of patients with UTIs treated with empiric penicillin- or cephalosporin-based antibiotics from January 1, 2017, to December 31, 2018. We compared outcomes in cases with ESBL E. coli UTI with age-matched controls with a cephalosporin-susceptible E. coli UTI. Logistic regression was used to compare the odds of clinical failure (persistent symptoms and/or fever) at 48–72 hours. We further evaluated the odds of hospitalization and UTI recurrence between groups. Results: Of the 228 enrolled patients, 51 were cases and 177 controls. Cases were more likely to have underlying medical conditions (45% vs 21%). The odd ratio of clinical failure at 48–72 hours after initiation for cases compared to controls was 4.83 (95% CI, 0.94–24.92; P = .06). These odds were was not influenced by age, presence of an underlying medical condition, or fever. The overall adjusted odd ratio of hospitalization for cases compared to controls was 12.09 (95% CI, 0.995–4.38, P = .052). Most patients admitted at presentation had an underlying medical condition (30 of 64, 47%) and/or fever (54 of 64, 84%). Among 30 cases initially managed as outpatients, only 2 (7%) were later admitted due to clinical failure. There was no difference in the likelihood of UTI recurrence within 60 days for the 2 groups (adjusted OR, 1.34; 95% CI, 0.47–3.78; P = .58). Conclusions: At 48–72 hours, there was no significant difference in the odds of clinical failure for patients with ESBL E. coli UTI compared to patients with non-ESBL E. coli UTI receiving empiric noncarbapenem therapy. Although we detected a trend toward a higher odds of hospitalization among cases, this result was largely due to a higher clinical complexity among cases at baseline. Only 2 cases required admission for failure of outpatient therapy. There was no increased risk of UTI recurrence among cases. This study suggests that initial discordant antibiotic therapy may not increase the risk of a poor outcome in children with ESBL E. coli UTI.Funding: NoneDisclosures: None

scholarly journals 1483. Comparison of Outcomes in Urinary Tract Infections Caused by SPICE Organisms Treated with Non-Carbapenem-β-lactams vs. Non-β-lactams Agents

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S540-S541
Author(s):  
Julia Sapozhnikov ◽  
Angela Huang ◽  
Kelsey Powell ◽  
Allison Gibble
Keyword(s):  
Urinary Tract ◽  
Hospital Stay ◽  
Clinical Response ◽  
Urinary Tract Infections ◽  
Antimicrobial Agents ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
All Cause Mortality ◽  
Tract Infections ◽  
Infection Recurrence

Abstract Background The “SPICE organisms” intrinsically produce low levels of a chromosomally encoded β-lactamase enzyme, AmpC. When SPICE organisms are exposed to certain antimicrobial agents, they can select for de-repressed mutants and induce the AmpC gene. No study to date has determined the optimal treatment of lower inoculum infections such as urinary tract infections (UTIs) caused by SPICE organisms. Methods This study is a single-center, retrospective observational review of adult hospitalized patients with a UTI caused by a SPICE organism from November 2012 to November 2015. The objective of this study was to compare outcomes amongst patients with UTIs caused by select SPICE organisms treated with drugs susceptible to AmpC hydrolysis (penicillins, cephalosporins except cefepime, and monobactams) vs. drugs stable against AmpC (carbapenems, cefepime, and non-β-lactam agents). The primary outcome was clinical response, defined as resolution of signs and symptoms of UTI without requiring escalation of antimicrobial therapy after 48 hours of therapy initiation. Secondary outcomes include 30-day infection-related readmission, 30-day infection recurrence rate, 30-day all-cause mortality, and length of hospital stay. Patients with resistance to ceftriaxone were reviewed for β-lactam exposure (≥7 days) within the last month. Results One-hundred 56 patients were identified. Clinical response, 30-day infection-related readmission, 30-day infection recurrence, 30-day mortality rates, and median length of hospital stay were similar between the AmpC stable and AmpC susceptible groups (Table 1). Notably, 39.1% of patients with ceftriaxone resistance reported had recent β-lactam exposure vs. only 11.6% of patients without ceftriaxone resistance (P = 0.0028). Conclusion Based our data, there does not appear to be a difference in clinical response, 30-day-related readmission, 30-day infection recurrence, 30-day all-cause mortality rates, or length of stay in patients with UTIs treated with AmpC stable and AmpC susceptible agents. AmpC induction can be seen with at least 7 days of β-lactam use in the past 30 days as demonstrated by more frequent use of recent β-lactam agents in those with ceftriaxone resistance detected. Disclosures All authors: No reported disclosures.

scholarly journals Poor Clinical Outcomes Associated with Community-Onset Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae Urinary Tract Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S347-S347
Author(s):  
Judith Anesi ◽  
Ebbing Lautenbach ◽  
Irving Nachamkin ◽  
Charles Garrigan ◽  
Warren Bilker ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Urinary Tract Infections ◽  
Antibiotic Prescribing ◽  
Clinical Failure ◽  
Extended Spectrum ◽  
Initial Antibiotic Therapy ◽  
Tract Infections ◽  
Community Onset

Abstract Background Urinary tract infections (UTIs) are the most common bacterial infection among adults in the community. Recent data suggest an increase in bacterial resistance to first line antibiotics used for UTI, though the impact on clinical outcomes is unclear. The objective of our study was to determine clinical outcomes associated with community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) UTI. Methods A retrospective cohort study was conducted in a large health system from 2010 to 2013. All patients presenting to an emergency department or outpatient clinic with UTI due to EB were included. Exposed subjects were those with an EB demonstrating resistance to an ESC (ceftriaxone or ceftazidime). Unexposed subjects were those with ESC-susceptible EB UTIs and were matched to cases 1:1 based on study year. Multivariable logistic regression analyses were performed to evaluate the association between ESC-R EB UTI and 1) clinical failure (defined as ongoing symptoms, repeat positive culture, or need for additional antibiotics within 7 days); 2) inappropriate initial antibiotic therapy (IIAT) (defined as failure to receive an antibiotic to which the organism was susceptible within 48 hours of presentation). Results A total of 302 patients with community-onset EB UTI were included. On multivariable analyses, a UTI with an ESC-R EB was significantly associated with clinical failure (odds ratio [OR] 5.12, 95% confidence interval [CI] 2.79–9.39, P < 0.01). Other variables independently associated with clinical failure included presence of pyelonephritis at the time of UTI diagnosis (OR 2.15, 95% CI 1.14–4.03, p 0.02) and infection with Citrobacter species (OR 29.56, 95% CI 4.46–195.91, P < 0.01). ESC-R EB UTI was also associated with IIAT on multivariable analysis (OR 3.73, 95% CI 2.25–6.21, P < 0.01). Conclusion Community-onset UTI due to an ESC-R EB organism is associated with a significantly increased risk of clinical failure, which may be due in part to the use of inappropriate initial antibiotic therapy. Further studies are needed to determine which patients in the community are at high risk for drug-resistant infection to help inform prompt urine culture ordering and appropriate antibiotic prescribing for ESC-R EB. Disclosures All authors: No reported disclosures.

scholarly journals Piperacillin-Tazobactam Versus Carbapenems for the Treatment of Nonbacteremic Urinary Tract Infections due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

2018 ◽  
Vol 55 (1) ◽  
pp. 44-49
Author(s):  
Jordan Brooke Tullos ◽  
Laura Leigh Stoudenmire ◽  
Jonathon David Pouliot
Keyword(s):  
Urinary Tract ◽  
Clinical Response ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Primary Objective ◽  
Current Evidence ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Tract Infections

Background: Carbapenems are the drug of choice for treatment of infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Current evidence regarding piperacillin-tazobactam (PTZ) as an effective treatment alternative remains controversial. The purpose of this study was to determine the efficacy of PTZ versus carbapenems for treatment of nonbacteremic urinary tract infections (UTIs) due to ESBL-producing Enterobacteriaceae. Methods: A retrospective cohort study of patients treated for ESBL-related UTIs was conducted at three medical centers in the greater Middle Tennessee area. Patients were included if they were ≥ 18 years old, had a positive urine culture with an ESBL-producing organism, and received ≥ 48 hours of treatment with PTZ or carbapenem. Patients with bacteremia as well as those with isolates resistant to the treatment regimen selected were excluded. The primary objective was to determine the difference in clinical response between PTZ and carbapenem for treatment of ESBL-related UTIs. Clinical response was defined as absence of all of the following: (1) repeat admission for UTI caused by the same organism within 6 months, (2) repeat urine culture within 6 months showing growth of the same organism, or (3) a change in antimicrobial regimen due to subjective failure as determined by the ordering provider. Results: A total of 180 patients were included in the analysis (PTZ = 39; carbapenem = 141). There was no difference in clinical response between patients receiving PTZ and carbapenem (74.4% versus 80.9%; P = .38). Conclusion: PTZ may be an effective alternative to carbapenems for treatment of nonbacteremic UTIs due to ESBL-producing Enterobacteriaceae.

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