Korean J Intern Med.  2016 Jan;31(1):156-161. 10.3904/kjim.2016.31.1.156.

Amikacin therapy for urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli

• Cho SY
• Choi SM
• Park SH
• Lee DG
• Choi JH
• Yoo JH

• KMID: 2373784
• DOI: http://doi.org/10.3904/kjim.2016.31.1.156

Abstract

BACKGROUND/AIMS
The number of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem.
METHODS
We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC.
RESULTS
From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity.
CONCLUSIONS
Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources.

Keyword

Amikacin; Beta-lactamases; Outpatients; Urinary tract infections

MeSH Terms

Adult
Aged
Aged, 80 and over
Ambulatory Care
Amikacin/administration & dosage/adverse effects/*therapeutic use
Drug Administration Schedule
Escherichia coli/*drug effects/enzymology/isolation & purification
Escherichia coli Infections/diagnosis/*drug therapy/microbiology/urine
Humans
Microbial Sensitivity Tests
Middle Aged
Recurrence
Remission Induction
Retrospective Studies
Time Factors
Treatment Outcome
Urinalysis
Urinary Tract Infections/diagnosis/*drug therapy/microbiology/urine
Urine/microbiology
beta-Lactamase Inhibitors/administration & dosage/adverse effects/*therapeutic use
beta-Lactamases/*metabolism
Amikacin
beta-Lactamases