From the Guidelines
ESBL in urine requires prompt treatment with a carbapenem, such as meropenem (1g IV every 8 hours) or ertapenem (1g IV daily), for 7-14 days, as recommended by the European Association of Urology guidelines 1. The presence of ESBL-producing organisms in urine is a complicating factor in urinary tract infections, often associated with antimicrobial resistance 1.
- Key factors to consider in the management of ESBL in urine include:
- Severity of the illness at presentation
- Local resistance patterns
- Specific host factors, such as allergies
- Underlying urological abnormalities or complicating factors
- Treatment should be tailored to the individual patient, with initial empiric therapy followed by targeted therapy based on urine culture and susceptibility testing 1.
- The duration of treatment should be closely related to the treatment of the underlying abnormality, with a minimum of 7 days and up to 14 days for men when prostatitis cannot be excluded 1.
- In cases where short-course treatment is desirable, a shorter treatment duration of 7 days may be considered when the patient is haemodynamically stable and has been afebrile for at least 48 hours 1.
From the Research
ESBL in Urine
- ESBL-producing Enterobacteriaceae are a growing concern in hospitalized patients, and urinary tract infections (UTIs) are a common presentation 2, 3.
- The most common causative organisms of ESBL-producing UTIs are ESBL-producing Klebsiella pneumoniae and Escherichia coli 2.
- Carbapenems, such as meropenem and imipenem, are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections, including UTIs 4.
- However, alternatives to carbapenems, such as cephamycins, fluoroquinolones, and β-lactam/β-lactam inhibitor combinations (e.g., piperacillin/tazobactam), can be considered for the treatment of ESBL-producing UTIs, especially in patients with less severe presentations or in areas with low carbapenem resistance 4, 5.
- Ertapenem, a once-daily carbapenem, has been shown to be effective against ESBL-producing UTIs, with clinical response and microbiologic cure rates similar to those of other carbapenems 2.
- Pharmacodynamic modeling suggests that imipenem and meropenem may have a greater likelihood of achieving pharmacodynamic targets against ESBL-producing bacteria than ertapenem or fluoroquinolones 6.
- The emergence of ESBL-producing Enterobacteriaceae as a common cause of UTIs in the United States highlights the need for awareness and appropriate treatment strategies, including the use of in vitro-active antibiotics and consideration of local resistance patterns 3.