From the Guidelines
Meropenem is an appropriate treatment option for a urinary tract infection (UTI) in a patient with bilateral percutaneous nephrostomy tubes, particularly when dealing with complicated UTIs or resistant organisms, with a recommended dosage of 1 gram intravenously every 8 hours for 7 days, as supported by the most recent guidelines 1.
Key Considerations
- The patient's condition, with bilateral percutaneous nephrostomy tubes, increases the risk for complicated infections with resistant organisms, making meropenem a valuable treatment option due to its broad-spectrum coverage, including extended-spectrum beta-lactamase (ESBL) producing organisms.
- The dosage of meropenem should be adjusted according to renal function, as patients with nephrostomy tubes may have compromised kidney function, and monitoring renal function during treatment is crucial.
- Therapy should be guided by culture and sensitivity results when available, and narrower-spectrum antibiotics should be used if the organism is susceptible, to minimize the risk of resistance development and reduce potential side effects.
Treatment Duration
- According to the most recent guidelines 1, the recommended duration of treatment for acute pyelonephritis with dose-optimized β-lactams, such as meropenem, is 7 days.
- For febrile UTI, while there is insufficient evidence to provide a clear recommendation, it may be reasonable to treat in a similar fashion to pyelonephritis, considering the available data 1.
Important Notes
- The treatment of UTIs, especially in patients with complicated conditions like bilateral percutaneous nephrostomy tubes, should always prioritize the most recent and highest quality evidence to ensure the best outcomes in terms of morbidity, mortality, and quality of life.
- Regular review of the patient's response to treatment and adjustment of the antibiotic regimen as necessary, based on culture and sensitivity results, is essential for optimal management.
From the Research
Treatment of UTI with Meropenem
- Meropenem is a broad-spectrum antibacterial agent of the carbapenem family, indicated for the treatment of serious bacterial infections, including complicated urinary tract infections (cUTIs) 2.
- Meropenem has a broad spectrum of in vitro activity against Gram-positive and Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 2.
- Meropenem/vaborbactam is a combination of meropenem and a beta-lactamase inhibitor, approved for the treatment of cUTIs, including pyelonephritis, and has shown excellent in vitro activity against Gram-negative clinical isolates, including KPC- and ESBL-producing Enterobacteriaceae 3.
Use of Meropenem in Patients with BL Perc Tubes
- There is no specific information in the provided studies regarding the use of meropenem in patients with BL perc tubes.
- However, meropenem is generally considered a suitable option for the treatment of cUTIs, including those caused by ESBL-producing Enterobacteriaceae 4, 5.
- The choice of antibiotic therapy should be guided by the results of urine culture and susceptibility testing, as well as local antimicrobial resistance patterns 4, 5, 6.
Antimicrobial Resistance Patterns
- The study by 6 found that the spectrum of antimicrobial resistance among Gram-negative bacteria associated with UTIs is changing over time, with significant increases in resistance to some antibiotics and decreases in resistance to others.
- The study highlights the importance of keeping up-to-date with local antimicrobial resistance patterns and using this information to guide antibiotic prescribing decisions 6.