DOI: http://dx.doi.org/10.17305/bjbms.2018.3544 | Full Text: [Provisional PDF]

Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study

Kristian Karlović, Jadranka Nikolić, Jurica Arapović

Abstract


A frequent complication during hospital stay of patients with urinary tract infections (UTIs) is a re-infection of the urinary tract after the initial improvement. In this study, we investigated the impact of two empirical antibiotic therapies on the outcomes of complicated bacterial UTIs. We retrospectively evaluated 325 adult patients hospitalized during 6 years period with a diagnosis of complicated bacterial UTIs. The patients were classified into two groups according to the antibiotic therapy: ceftriaxone- and co-amoxiclav+gentamicin-treated group. Clinical data were collected from the patient records into a designed form. Output data included information on the treatment outcome, length of stay (LOS), development of complications, and cause of re-infections. The patients treated with ceftriaxone had significantly longer LOS (p = 0.012), as well as higher occurrence of complications (p = 0.023) and urinary tract re-infections (p < 0.001), compared to co-amoxiclav+gentamicin-treated group. No significant difference was observed in the treatment outcome between the two groups (p = 0.137). The most common complication in both investigated groups were re-infections of the urinary tract, and Enterococcus spp. was detected as the cause of re-infections only in patients from ceftriaxone-treated group (40/69 patients). Out of the 40 ceftriaxone-treated patients with enterococcal urinary tract re-infections, 35 patients had one or more chronic diseases and 29 patients had urinary catheter inserted. Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay.


Keywords


Urinary tract infection; ceftriaxone; aminoglycosides; co-amoxiclav; re-infection; Enterococcus spp.

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References


American College of O, Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111(3):785-94.

Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228-41.

Gardner A, Mitchell B, Beckingham W, Fasugba O. A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals. BMJ Open. 2014;4:e005099.

Ackermann RJ, Monroe PW. Bacteremic urinary tract infection in older people. J Am Geriatr Soc. 1996;44:927-33.

Deulofeu F, Cervello B, Capell S, Marti C, Mercade V. Predictors of mortality in patients with bacteremia: the importance of functional status. J Am Geriatr Soc. 1998;46:14-8.

Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113 Suppl 1A:5S-13S.

Jackson SL, Boyko EJ, Scholes D, Abraham L, Gupta K, Fihn SD. Predictors of urinary tract infection after menopause: a prospective study. Am J Med. 2004;117:903-11.

Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Urinary incontinence and diabetes in postmenopausal women. Diabetes Care. 2005;28:1730-8.

Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care. 2002;17:50-7.

Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters--is infection the greatest risk? J Urol. 2012;187:1662-6.

Litza JA, Brill JR. Urinary tract infections. Prim Care. 2010;37:491-507, viii.

Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29:73-9.

Skerk V, Andrasevic AT, Andrasevic S, Susic E, Dzepina AM, Madaric V, et al. [ISKRA guidelines on antimicrobial treatment and prophylaxis of urinary tract infections--Croatian national guidelines]. Lijec Vjesn. 2009;131:105-18.

Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis. 1992;15 Suppl 1:S216-27.

Khasawneh FA, Karim A, Mahmood T, Ahmed S, Jaffri SF, Tate ME, et al. Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome. Infection. 2014;42(5):829-34.

Barnes AI, Herrero IL, Albesa I. New aspect of the synergistic antibacterial action of ampicillin and gentamicin. Int J Antimicrob Agents. 2005;26:146-51.

Prins JM, Buller HR, Kuijper EJ, Tange RA, Speelman P. Once versus thrice daily gentamicin in patients with serious infections. Lancet. 1993;341:335-9.

Prins JM, Weverling GJ, de Blok K, van Ketel RJ, Speelman P. Validation and nephrotoxicity of a simplified once-daily aminoglycoside dosing schedule and guidelines for monitoring therapy. Antimicrob Agents Chemother. 1996;40:2494-9.

Wu YR, Rego LL, Christie AL, Lavelle RS, Alhalabi F, Zimmern PE. Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women-Does This Factor Impact Upper Tract Imaging Findings? J Urol. 2016;196(2):422-8.

Chin BS, Kim MS, Han SH, Shin SY, Choi HK, Chae YT, et al. Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients. Arch Gerontol Geriatr. 2011;52:e50-5.

Tal S, Guller V, Levi S, Bardenstein R, Berger D, Gurevich I, et al. Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection. J Infect. 2005;50:296-305.

Cornia PB, Takahashi TA, Lipsky BA. The microbiology of bacteriuria in men: a 5-year study at a Veterans' Affairs hospital. Diagn Microbiol Infect Dis. 2006;56:25-30.

Vemuri RK, Zervos MJ. Enterococcal infections. The increasing threat of nosocomial spread and drug resistance. Postgrad Med. 1993;93(3):121-4, 7-8.

Lloyd S, Zervos M, Mahayni R, Lundstrom T. Risk factors for enterococcal urinary tract infection and colonization in a rehabilitation facility. Am J Infect Control. 1998;26(1):35-9.

Pallares R, Pujol M, Pena C, Ariza J, Martin R, Gudiol F. Cephalosporins as risk factor for nosocomial Enterococcus faecalis bacteremia. A matched case-control study. Arch Intern Med. 1993;153(13):1581-6.

Magnussen CR, Cave J. Nosocomial enterococcal infections: association with use of third-generation cephalosporin antibiotics. Am J Infect Control. 1988;16(6):241-5.

Pittet D, Li N, Woolson RF, Wenzel RP. Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis. 1997;24:1068-78.

Tseng CC, Wu JJ, Liu HL, Sung JM, Huang JJ. Roles of host and bacterial virulence factors in the development of upper urinary tract infection caused by Escherichia coli. Am J Kidney Dis. 2002;39:744-52.

Lark RL, Saint S, Chenoweth C, Zemencuk JK, Lipsky BA, Plorde JJ. Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome. Diagn Microbiol Infect Dis. 2001;41:15-22.

Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004;32:196-9.

Fakih MG, Shemes SP, Pena ME, Dyc N, Rey JE, Szpunar SM, et al. Urinary catheters in the emergency department: very elderly women are at high risk for unnecessary utilization. Am J Infect Control. 2010;38:683-8.

Ouslander JG, Griffiths P, McConnell E, Riolo L, Schnelle J. Functional Incidental Training: applicability and feasibility in the Veterans Affairs nursing home patient population. J Am Med Dir Assoc. 2005;6:121-7.

van Houten P, Achterberg W, Ribbe M. Urinary incontinence in disabled elderly women: a randomized clinical trial on the effect of training mobility and toileting skills to achieve independent toileting. Gerontology. 2007;53:205-10.

Sugimura T, Arnold E, English S, Moore J. Chronic suprapubic catheterization in the management of patients with spinal cord injuries: analysis of upper and lower urinary tract complications. BJU Int. 2008;101:1396-400.

Banerjee SN, Emori TG, Culver DH, Gaynes RP, Jarvis WR, Horan T, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):86S-9S.

Morrison AJ, Jr., Wenzel RP. Nosocomial urinary tract infections due to enterococcus. Ten years' experience at a university hospital. Arch Intern Med. 1986;146(8):1549-51.

Adesida SA, Ezenta CC, Adagbada AO, Aladesokan AA, Coker AO. Carriage of Multidrug Resistant Enterococcus Faecium and Enterococcus Faecalis among Apparently Healthy Humans. Afr J Infect Dis. 2017;11(2):83-9.

Pinholt M, Ostergaard C, Arpi M, Bruun NE, Schonheyder HC, Gradel KO, et al. Incidence, clinical characteristics and 30-day mortality of enterococcal bacteraemia in Denmark 2006-2009: a population-based cohort study. Clin Microbiol Infect. 2014;20(2):145-51.

Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991;115(8):585-90.

Choi SH, Lee JE, Park SJ, Choi SH, Lee SO, Jeong JY, et al. Emergence of antibiotic resistance during therapy for infections caused by Enterobacteriaceae producing AmpC beta-lactamase: implications for antibiotic use. Antimicrob Agents Chemother. 2008;52(3):995-1000.

Billington EO, Phang SH, Gregson DB, Pitout JD, Ross T, Church DL, et al. Incidence, risk factors, and outcomes for Enterococcus spp. blood stream infections: a population-based study. Int J Infect Dis. 2014;26:76-82.

McBride SJ, Upton A, Roberts SA. Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia--a five-year retrospective review. Eur J Clin Microbiol Infect Dis. 2010;29(1):107-14.

Vigani AG, Oliveira AM, Bratfich OJ, Stucchi RS, Moretti ML. Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis. Braz J Med Biol Res. 2008;41(10):890-5.

Gruber I, Heudorf U, Werner G, Pfeifer Y, Imirzalioglu C, Ackermann H, et al. Multidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care--prevalence and risk factors. Int J Med Microbiol. 2013;303(8):405-9.

Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7:342-7.

Keten D, Aktas F, Guzel Tunccan O, Dizbay M, Kalkanci A, Biter G, et al. Catheter-associated urinary tract infections in intensive care units at a university hospital in Turkey. Bosn J Basic Med Sci. 2014;14(4):227-33.


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