From the Guidelines
Meropenem/vaborbactam is the recommended carbapenem for treating urinary tract infections (UTIs) caused by multi-drug resistant gram-negative (MDRGN) organisms, with a dosage of 4g intravenously every 8 hours for 5-7 days, depending on the severity of infection and clinical response. This recommendation is based on the latest guidelines and evidence from the Journal of Microbiology, Immunology and Infection 1 and Clinical Microbiology and Infection 1.
Key Considerations
- The choice of carbapenem should be guided by susceptibility testing and local resistance patterns.
- Meropenem/vaborbactam has been shown to be effective against MDRGN organisms, including those with carbapenem-resistant Enterobacterales (CRE) 1.
- For patients with renal impairment, dose adjustment is necessary, and monitoring of renal function during treatment is crucial.
- Step-down therapy to oral options based on susceptibility results after clinical improvement should be considered to complete the treatment course.
Alternative Options
- Ceftazidime/avibactam and imipenem/cilastatin/relebactam are alternative options for treating UTIs caused by MDRGN organisms, but their use should be guided by susceptibility testing and local resistance patterns 1.
- Ertapenem could be considered for non-Pseudomonal MDRGN infections at 1g IV daily, offering the advantage of once-daily dosing.
Implementation
- Ensure susceptibility testing is performed before initiating therapy.
- Monitor renal function during treatment.
- Consider step-down therapy to oral options based on susceptibility results after clinical improvement to complete the treatment course.
From the FDA Drug Label
1.2 Urinary Tract Infections (complicated and uncomplicated) Imipenem and Cilastatin for Injection, USP (I.V.) is indicated for the treatment of urinary tract infections (complicated and uncomplicated) caused by susceptible strains of Enterococcus faecalis, Staphylococcus aureus (penicillinase-producing isolates), Enterobacter species, Escherichia coli, Klebsiella species, Morganella morganii, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa.
The best carbapenem for UTI MDRGN is not explicitly stated in the provided drug labels. However, based on the information provided, Imipenem is indicated for the treatment of urinary tract infections (complicated and uncomplicated) caused by susceptible strains of various bacteria, including some that may be MDRGN.
- Key points:
- Imipenem has a broad spectrum of activity against Gram-positive and Gram-negative bacteria.
- It is effective against many bacteria that cause UTIs, including some that may be resistant to other antibiotics.
- However, the effectiveness of imipenem against MDRGN specifically is not explicitly stated in the provided drug labels. 2 2
From the Research
Treatment Options for UTI MDRGN
- The treatment of urinary tract infections (UTIs) caused by multidrug-resistant Gram-negative bacteria (MDRGN) is challenging due to limited treatment options 3, 4.
- Carbapenems, such as meropenem/vaborbactam and imipenem/cilastatin-relebactam, are effective against MDRGN, including ESBL-producing Enterobacteriales and carbapenem-resistant Enterobacteriales (CRE) 3, 4, 5.
- Meropenem/vaborbactam and imipenem/cilastatin-relebactam are recommended as parenteral treatment options for UTIs due to ESBL-producing Enterobacteriales and CRE 3, 4.
- Ceftazidime-avibactam, ceftolozane-tazobactam, and cefiderocol are also effective against MDRGN, including Pseudomonas aeruginosa and Acinetobacter baumannii 3, 4, 5, 6.
Comparison of Carbapenems
- Meropenem and imipenem have similar microbiological activity, but meropenem has slightly greater gram-negative activity against organisms like Pseudomonas aeruginosa and Burkholderia cepacia 7.
- Imipenem demonstrates more intense gram-positive activity, particularly towards Enterococcus faecalis 7.
- Meropenem has an advantage over imipenem due to less frequent dosing and the ability to administer by rapid intravenous injection 7.
Best Carbapenem for UTI MDRGN
- Based on the available evidence, meropenem/vaborbactam and imipenem/cilastatin-relebactam are effective treatment options for UTIs caused by MDRGN 3, 4, 5.
- The choice of carbapenem may depend on the specific organism and its mechanism of resistance, as well as the patient's clinical condition and renal function 3, 4, 6.