Vol.64 No.3 May 2016
The use of antibiotics to urinary tract infection in consideration of the drug resistant bacteria -The effort from infection control-
Department of Infection Prevention and Control, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, Japan
Abstract
We report herein on the increase in urinary tract infections by resistant bacteria, and focus on the extended spectrum of beta-lactamase-producing bacteria (ESBLs) and carbapenem-resistant enterobacteriaceae (CRE). Carbapenem is effective in the treatment of ESBLs; however, excessive usage of carbapenem carries the risk of developing carbapenem-resistant Pseudomonas aeruginosa. In order to avoid excessive use of carbapenems, it is necessary to consider the use of alternative drugs. Although alternatives have shown activity against ESBLs in vitro, the actual efficacy in clinical practice remains controversial, especially with cephamycin/oxacephem. Alternatives to carbapenems were indicated in patients: (a) with mild to moderate severity (without evidence of severe sepsis); (b) in whom isolates were susceptible to empirically used alternatives, and a favorable clinical course was obtained; and additionally (c) alternatives were used in patients with prolonged carbapenem use for ESBLs therapy. Twenty-nine patients with urinary tract infection caused by ESBLs were treated. Clinical success rates were 100% using carbapenems, 62.5% with tazobactam/piperacillin, 72.2% with oxacephem/cephamycin, and 66.7% with new quinolone. Although the use of these alternatives is not appropriate in severe cases, they should be a treatment option in mild cases. The emergence of CRE is a global topic, and we experienced an outbreak and infective case of CRE at our hospital. In this case, we treated urosepsis with tobramycin and fosfomycin. In many cases, CRE is able to spread through facilities or urine, therefore it is important to prevent transmission to other patients.
Key word
ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, urinary tract infection
Received
November 12, 2014
Accepted
January 7, 2016
Jpn. J. Chemother. 64 (3): 513-517, 2016
