A Brief Review of a New Antibiotic: Meropenem-vaborbactam

2019 ◽  
Vol 34 (3) ◽  
pp. 187-191
Author(s):  
Benjamin Gibson
Keyword(s):  
Cytochrome P450 ◽  
Urinary Tract ◽  
Side Effects ◽  
Drug Interactions ◽  
Urinary Tract Infections ◽  
Dose Adjustment ◽  
Bacterial Resistance ◽  
Blood Levels ◽  
Cytochrome P450 Enzymes ◽  
Tract Infections

Meropenem-vaborbactam is a newly approved antibiotic for complex urinary tract infections and to treat carbapenem-resistant Enterobacteriaceae infections. Its advantage over meropenem is the betalactamase inhibitor which slows bacterial resistance. This medication has been studied in numerous countries and has relatively few side effects. There were slightly higher incidences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), elevations, infusion site phlebitis, but less anemia, vaginal infections, and discontinuation when compared with pipercacilin-tazobactam.<br/> The combination drug's relevance for the geriatrician is that older adults are at higher risk for urinary tract infections (UTIs). Some drugs that had previously been prescribed are now less useful for treating UTIs. This leaves clinicians with drugs that have more side effects.<br/> This new drug has two significant drug interactions. Meropenem competes with probenecid in the kidney's tubular secretion. This increases the concentration of meropenem. Meropenem lessens valproic acid blood levels, putting patients at risk for seizures. It is not known to impact cytochrome p450 enzymes. It comes as a dry powder and should be diluted in 250 mL of normal saline and given over a three-hour infusion.<br/> Vaborbactam is not known to have drug interactions. Vaborbactam does not affect the cytochrome p450 enzymes. This antibiotic has been studied in patients as old as 92 years. Renal dose adjustment allows the medication to be administered safely at all stages of kidney disease. If a patient is on dialysis, it is to be given after dialysis. No dose adjustment is needed based on the Child-Pugh score (i.e., for hepatic function). Based on local resistance, it may be beneficial to add this medication to one's formulary.

scholarly journals Dispensing of Food Supplements in the Treatment and Prevention of Urinary Tract Infections

2021 ◽  
Vol 5 (1) ◽  
pp. 1
Author(s):  
Beatriz Setoca ◽  
Ana I. Fernandes
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Health Professionals ◽  
Bacterial Resistance ◽  
Food Supplements ◽  
Public Health Issue ◽  
Therapeutic Approaches ◽  
Treatment And Prevention ◽  
Tract Infections ◽  
Perception Of Health

Urinary tract infections constitute an important public health issue due to recurrence and antibiotic resistance. Currently, antibiotics are the standard therapy but non-antibiotic approaches, such as food supplements, could be beneficial and reduce bacterial resistance. This work aimed at a better understanding of the perception of health professionals involved in dispensing and counselling, in the community pharmacy, regarding the utility of these products as preventive alternatives and therapeutic approaches.

Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Chemotherapy ◽  
2016 ◽  
Vol 62 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Stephanie E. Giancola ◽  
Monica V. Mahoney ◽  
Michael D. Hogan ◽  
Brian R. Raux ◽  
Christopher McCoy ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Clinical Success ◽  
Patient Characteristics ◽  
Multidrug Resistant ◽  
Enterococcus Spp ◽  
Tract Infections ◽  
Microbiological Cure

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

scholarly journals Changes in bacterial resistance patterns in children with urinary tract infections on antimicrobial prophylaxis at University Hospital in Split

2011 ◽  
Vol 17 (7) ◽  
pp. CR355-CR361 ◽  
Author(s):  
Tanja Ilić ◽  
Sanda Gračan ◽  
Adela Arapović ◽  
Vesna Čapkun ◽  
Mirna Šubat-Dežulović ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Antimicrobial Prophylaxis ◽  
University Hospital ◽  
Resistance Patterns ◽  
Tract Infections

scholarly journals Bacterial Resistance to Leucyl-tRNA Synthetase Inhibitor GSK2251052 Develops during Treatment of Complicated Urinary Tract Infections

2014 ◽  
Vol 59 (1) ◽  
pp. 289-298 ◽  
Author(s):  
Karen O'Dwyer ◽  
Aaron T. Spivak ◽  
Karen Ingraham ◽  
Sharon Min ◽  
David J. Holmes ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Multidrug Resistant ◽  
Trna Synthetase ◽  
Content Type ◽  
Development Of Resistance ◽  
Tract Infections ◽  
Abdominal Infections

ABSTRACTGSK2251052, a novel leucyl-tRNA synthetase (LeuRS) inhibitor, was in development for the treatment of infections caused by multidrug-resistant Gram-negative pathogens. In a phase II study (study LRS114688) evaluating the efficacy of GSK2251052 in complicated urinary tract infections, resistance developed very rapidly in 3 of 14 subjects enrolled, with ≥32-fold increases in the GSK2251052 MIC of the infecting pathogen being detected. A fourth subject did not exhibit the development of resistance in the baseline pathogen but posttherapy did present with a different pathogen resistant to GSK2251052. Whole-genome DNA sequencing ofEscherichia coliisolates collected longitudinally from two study LRS114688 subjects confirmed that GSK2251052 resistance was due to specific mutations, selected on the first day of therapy, in the LeuRS editing domain. Phylogenetic analysis strongly suggested that resistantEscherichia coliisolates resulted from clonal expansion of baseline susceptible strains. This resistance development likely resulted from the confluence of multiple factors, of which only some can be assessed preclinically. Our study shows the challenges of developing antibiotics and the importance of clinical studies to evaluate their effect on disease pathogenesis. (These studies have been registered at ClinicalTrials.gov under registration no. NCT01381549 for the study of complicated urinary tract infections and registration no. NCT01381562 for the study of complicated intra-abdominal infections.)

scholarly journals Erratum to: The influence of antibiotic prophylaxis on bacterial resistance in urinary tract infections in children with spina bifida

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Sebastiaan Hermanus Johannes Zegers ◽  
Jeanne Dieleman ◽  
Tjomme van der Bruggen ◽  
Jan Kimpen ◽  
Catharine de Jong-de Vos van Steenwijk
Keyword(s):  
Urinary Tract ◽  
Spina Bifida ◽  
Antibiotic Prophylaxis ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Tract Infections

scholarly journals A Review of Pharmacotherapy in the Treatment of Urinary Disorders

2019 ◽  
Vol 4 (06) ◽  
Author(s):  
Dr Manoj G Tyagi
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Side Effects ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Future Prospects ◽  
Urinary Disorders ◽  
Bladder Disorders ◽  
Tract Infections

Urinary tract infections and other related pathophysiological conditions are a plethora of ailments affecting mankind. Ailments that are as common as the urinary tract infection, uropathy, incontinence, calculi and many other disorders. With the advancement of research into newer and more potent drugs with better efficacy and lesser side effects, treatment is becoming more specific and efficacious. This review examines the recent development in the treatment of these disorders and impressive progress in the pharmacotherapy, it also gives an overview of current and future prospects of drugs for bladder disorders.

Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Aurélien Dinh ◽  
Marie-Charlotte Hallouin-Bernard ◽  
Benjamin Davido ◽  
Adrien Lemaignen ◽  
Frédérique Bouchand ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Controlled Trial ◽  
Group Versus ◽  
Control Group ◽  
Recurrent Urinary Tract Infections ◽  
Cord Injury ◽  
Tract Infections

Abstract Background Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalizations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis (ie, the alternate weekly administration of 2 antibiotics) in preventing R-UTIs. Methods Randomized (1:1), open-label, superiority-controlled trial compared WOCA prophylaxis to no prophylaxis (control) for 6 months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome was incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes were number of febrile UTIs, number of hospitalizations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal, and nasal microbiota. Results Forty-five patients were either allocated to the WOCA group (n = 23) or the control group (n = 22). Median (IQR) incidence of symptomatic antibiotic-treated UTIs was 1.0 (0.5–2.5) in the WOCA group versus 2.5 (1.2–4.0) (P = .0241) in the control group. No febrile UTIs were recorded in the WOCA group versus 9 (45.0%) (P &lt; .001) in the control group. The median number of additional antibiotic treatment was 0.0 (IQR, 0.0–2.0) versus 3.0 (2.0–5.0) (P = .004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. Conclusions WOCA is efficient and well tolerated in preventing R-UTIs in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures. Clinical Trials Registration NCT01388413.

scholarly journals 1168. Role of Extended-Spectrum Cephalosporin-Resistance in Recurrent Enterobacteriaceae Urinary Tract Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S352-S352
Author(s):  
Judith Anesi ◽  
Ebbing Lautenbach ◽  
Irving Nachamkin ◽  
Charles Garrigan ◽  
Warren Bilker ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Treatment Regimens ◽  
Recurrent Uti ◽  
Time To Recurrence ◽  
Extended Spectrum ◽  
Cox Proportional Hazard Regression ◽  
Tract Infections ◽  
Community Onset

Abstract Background Recent data have shown an increase in bacterial resistance to first-line antibiotics used to treat community-onset urinary tract infections (UTIs). A better understanding of the clinical outcomes associated with drug-resistant UTIs in the community is needed. We sought to determine the association between community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) UTI and the risk for recurrent UTI. Methods A retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed subjects 1:1 on study year. Multivariable Cox proportional hazard regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months. Patients were censored at the time of first recurrent UTI or at the end of follow-up. Results A total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and unexposed. Within 12 months of the index UTI, 163 (54%) patients experienced a recurrent UTI. The median time to recurrence was 69 days (interquartile range 25–183 days). On multivariable analyses, a UTI due to an ESC-R EB was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01–1.91, P = 0.04). Other variables that were independently associated with an increased hazard of recurrent UTI included a history of UTI in the 6 months prior to the index UTI (HR 1.59, 95% CI 1.17–2.15, P &lt; 0.01) and presence of a urinary catheter at the time of the index UTI diagnosis (HR 1.59, 95% CI 1.06–2.38, P = 0.03). Conclusion Community-onset UTI due to an ESC-R EB organism is associated with a significantly increased hazard of recurrent UTI within 12 months even after adjusting for baseline factors that predispose patients to UTI recurrence. This study raises the question of whether patients with an ESC-R EB organism may require modified treatment regimens. Further study is needed to better elucidate the cause of recurrence among these patients. Disclosures All authors: No reported disclosures.

scholarly journals Propensity for biofilm formation by clinical isolates from urinary tract infections: developing a multifactorial predictive model to improve antibiotherapy

2014 ◽  
Vol 63 (3) ◽  
pp. 471-477 ◽  
Author(s):  
Maria José Alves ◽  
João C. M. Barreira ◽  
Inês Carvalho ◽  
Luis Trinta ◽  
Liliana Perreira ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Predictive Model ◽  
Urinary Tract Infections ◽  
Biofilm Formation ◽  
Bacterial Resistance ◽  
Therapeutic Option ◽  
Bacterial Species ◽  
Acid Synthesis ◽  
Biofilm Production ◽  
Tract Infections

A group of biofilm-producing bacteria isolated from patients with urinary tract infections was evaluated, identifying the main factors contributing to biofilm formation. Among the 156 isolates, 58 (37.2 %) were biofilm producers. The bacterial species (P<0.001), together with patient’s gender (P = 0.022), were the factors with the highest influence for biofilm production. There was also a strong correlation of catheterization with biofilm formation, despite being less significant (P = 0.070) than species or gender. In fact, some of the bacteria isolated were biofilm producers in all cases. With regard to resistance profile among bacterial isolates, β-lactam antibiotics presented the highest number of cases/percentages – ampicillin (32/55.2 %), cephalothin (30/51.7 %), amoxicillin/clavulanic acid (22/37.9 %) – although the carbapenem group still represented a good therapeutic option (2/3.4 %). Quinolones (nucleic acid synthesis inhibitors) also showed high resistance percentages. Furthermore, biofilm production clearly increases bacterial resistance. Almost half of the biofilm-producing bacteria showed resistance against at least three different groups of antibiotics. Bacterial resistance is often associated with catheterization. Accordingly, intrinsic (age and gender) and extrinsic (hospital unit, bacterial isolate and catheterization) factors were used to build a predictive model, by evaluating the contribution of each factor to biofilm production. In this way, it is possible to anticipate biofilm occurrence immediately after bacterial identification, allowing selection of a more effective antibiotic (among the susceptibility options suggested by the antibiogram) against biofilm-producing bacteria. This approach reduces the putative bacterial resistance during treatment, and the consequent need to adjust antibiotherapy.

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