Comparison of fosfomycin to ertapenem for outpatient or step-down therapy of extended-spectrum β-lactamase urinary tract infections.
Veve MP, Wagner JL, Kenney RM, Grunwald JL, and Davis SL. Comparison of fosfomycin to ertapenem for outpatient or step-down therapy of extended-spectrum beta-lactamase urinary tract infections Int J Antimicrob Agents 2016; Jul;48(1):56-60.
International journal of antimicrobial agents
Extended-spectrum β-lactamase (ESBL) enzymes cause resistance to common β-lactam antibiotics and are associated with poor outcomes. Management of ESBL urinary tract infections (UTIs) is challenging given the limited treatment options available outside the hospital setting. In this study, the primary endpoint of UTI-related 30-day hospital re-admission or emergency department/clinic revisit rates was compared for fosfomycin and ertapenem outpatient ESBL UTI treatments. A retrospective cohort study was performed on patients with ESBL UTIs treated with outpatient fosfomycin or ertapenem from January 2010 to February 2015. Inclusion criteria were age ≥18 years, outpatient treatment with fosfomycin or ertapenem for symptomatic ESBL UTI, and positive urine cultures with microbiologically proven ESBL-producing bacteria. A non-inferiority margin of 0.15 was selected to detect a difference in the primary endpoint. Patient and infection characteristics were compared. A sensitivity analysis with propensity score matching was performed. In total, 178 patients were included (89 fosfomycin-treated and 89 ertapenem-treated). Ertapenem-treated patients received longer outpatient antibiotic treatment (10 days vs. 6 days; P
Medical Subject Headings
Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Enterobacteriaceae; Enterobacteriaceae Infections; Ertapenem; Female; Fosfomycin; Humans; Male; Middle Aged; Outpatients; Patient Readmission; Retrospective Studies; Treatment Outcome; Urinary Tract Infections; Young Adult; beta-Lactamases; beta-Lactams