Korean Journal of Healthcare-Associated Infection Control and Prevention (의료관련감염관리)

Korean Society for Healthcare-associated Infection Control and Prevention (대한의료관련감염관리학회)
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Use of Non-carbapenem Antibiotics in Patients with Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Enterobacteriaceae

Extended-spectrum β-lactamase 를 생산하는 Enterobacteriaceae 요로감염에서 카바페넴 이외의 항생제 사용 가능성에 대한 고찰

  • Seo, Yu Bin (Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Kim, Young Keun (Division of Infectious Diseases, Department of Internal Medicine, Yonsei Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Lee, Jacob (Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Song, Wonkeun (Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital)
  • 서유빈 (한림대학교부속 강남성심병원 감염내과) ;
  • 김영근 (연세대학교 원주의과대학 원주세브란스기독병원 감염내과) ;
  • 이재갑 (한림대학교부속 강남성심병원 감염내과) ;
  • 송원근 (한림대학교부속 강남성심병원 진단검사의학과)
  • Received : 2016.03.14
  • Accepted : 2016.06.24
  • Published : 2016.12.31
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Abstract

Background: Alternatives to carbapenem are increasingly needed to decrease the usage of carbapenem. We evaluated the possibility of using non-carbapenem antibiotics against urinary tract infections (UTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Methods: This retrospective study was performed at 2 university hospitals between October 2010 and December 2012. All diagnosed adult cases of ESBL-PE UTI were identified from the microbiological database. The subjects were divided into 3 groups based on the empirical antibiotic classes and susceptibility: carbapenem (C) group, susceptible non-carbapenem (SNC) group, and non-susceptible non-carbapenem (NSNC) group. Results: A total of 84 patients were eligible for analysis. For empirical therapy, 41, 23, and 20 patients were included in the NSNC, SNC, and C empirical groups, respectively. During the empirical therapy, 7 patients (17.1%) in the NSNC group, 18 patients (78.3%) in the SNC group, and 19 patients (78.3%) in the C group experienced clinical improvement. No significant difference was observed between the SNC and C empirical groups (P=0.192). Severe sepsis or shock was the predictor of empirical SNC treatment failure (P=0.048). There was a tendency to use carbapenem as a definite therapy in cases of NSNC. In contrast, empirical SNC was maintained as a definite therapy. Conclusion: SNC could be considered as an alternative to carbapenems for treating ESBL-PE UTI. This strategy might decrease the usage of carbapenem without clinical deterioration. However, it should be noted that SNC therapy may fail in the case of severe sepsis or shock.

ESBL을 생성하는 균주에 의한 요로 감염에서 카바페넴 계열 이외의 항생제를 사용할 수 있는 지를 후향적으로 평가한 연구이다. 만약 in vitro 결과에서 감수성이 있다면 사용이 가능하다는 결과이나 환자의 중증도가 높다면 실패할 수 있음을 강조하였다. 이번 연구 결과를 바탕으로 전향적 연구를 기대해 본다.

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Acknowledgement

This study was supported by a 2012 research grant from the Korea Health Industry Development Institute (No. A120843).