Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae

Abstract

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant Enterobacteriaceae urinary tract infections (UTIs) in the terms of demographic findings, antibiotic sensitivity patterns and clinical features along with the treatment options. This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients diagnosed with culture proven UTI due to carbapenem-resistant Klebsiella pneumoniae (between December 2016 to December 2017) were included in the study. Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria. A total number of 100 patients (34% female, mean age 61.69 ± 1.65 years) were included in this study. One month all-cause mortality rate was 19%. Microbiologic eradication rate was 88.7% while it was significantly higher in combination therapy (65/70 vs. 14/19, p = 0.019) and carbapenem long-lasting (4 h) infusion subgroups (54/56 vs. 2/56, p = 0.005). Relapse and reinfection rates were 61.7 and 29.7%, respectively. Logistic regression analysis for mortality risk factors resulted as history of ertapenem usage (OR: 4.74, 95% CI: 0.678–33.201, p = 0.117), lack of microbiologic eradication (OR: 21.7, 95% CI: 1.906–247.375, p = 0.013) and ICU stay (OR: 54.8, 95% CI: 4.145–726.324, p = 0.002). Combination, carbapenem long-lasting infusion and double carbapenem therapies seem to result in higher microbiologic eradication rates and thus may effect the mortality rates of these group of patients. Randomized-controlled studies should be performed in this critical patient group to confirm these results.

Keywords:

• Urinary tract infection
• carbapenem resistance
• Klebsiella pneumoniae
• treatment
• risk factors
• prognosis

Disclosure statement

All authors declare no conflict of interests.

Additional information

Notes on contributors

Uğur Önal

Uğur ÖNAL, Medical Doctor, graduated from Hacettepe University Faculty of Medicine; completed the residency from Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests sepsis, septic shock, urinary tract infections, antibiotic resistance.

Oğuz Reşat Sipahi, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: central nervous system infections, meningitis.

Hüsnü Pullukçu, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: urinary tract infections, toxoplasmosis.

Tansu Yamazhan, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: urinary tract infections, hepatitis.

Bilgin Arda, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: diabetic foot infections, fungal infections.

Sercan Ulusoy, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: antibiotics, diabetic foot infections, urinary tract infections.

Şöhret Aydemir, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Microbiology, Izmir/Turkey, research interests: bacteriology, microbiology, antibiotic resistance.

Meltem Işıkgöz Taşbakan, Professor Doctor, Ege Universiy Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir/Turkey, research interests: diabetic foot infections, urinary tract infections.