Outcomes of Aminopenicillin Therapy for Vancomycin-Resistant Enterococcal Urinary Tract Infections.
Antimicrob Agents Chemother. 2015 Sep 14;
Authors: Cole KA, Kenney RM, Perri MB, Dumkow LE, Samuel LP, Zervos MJ, Davis SL
Abstract
Vancomycin-resistant urinary tract infections are often challenging to treat. This retrospective cohort study compared outcomes between patients treated for vancomycin-resistant enterococcal urinary tract infection with an aminopenicillin versus a non-β-lactam antibiotic. Inpatients treated with an enterococcal-active agent for their first symptomatic vancomycin-resistant enterococcal urinary tract infection between January 1, 2012 and December 31, 2013 were considered for inclusion. Patients with colonization, on hospice or made comfort care were excluded. The primary endpoint of clinical cure was defined as resolution of clinical symptoms, or symptom improvement to the extent that no additional antibacterial drug therapy was necessary, and lack of microbiologic persistence. Secondary endpoints of 30-day readmission or retreatment and 30-day all-cause mortality were also compared. 316 urinary isolates were screened, 61 patients with symptomatic urinary tract infection were included, 20 (35%) of the 57 isolates tested were ampicillin susceptible. 31 patients received an aminopenicillin, 30 received non-β-lactam. Rates of clinical cure for aminopenicillin vs. non-β-lactam were 26/31 (83.9%) and 22/30 (73.3%) (p=0.315), respectively. Rates of 30-day readmission (6/31, 19.4% vs. 9/30, 30%, p=0.334), 30-day retreatment (4/31, 12.9% vs. 4/30, 13.3%, p=0.960), and 30-day all-cause mortality (2/31, 6.5% vs. 1/30, 3.3%, p=0.573) were also not significantly different between groups. Aminopenicillins may be a viable option for treating vancomycin-resistant urinary tract infection regardless of the organism's ampicillin susceptibility. Prospective validation with larger cohorts of patients should be considered.
PMID: 26369973 [PubMed - as supplied by publisher]