From the Guidelines
The most effective carbapenem for treating complicated urinary tract infections (UTIs) due to resistant organisms is meropenem, given its broad-spectrum activity and strong recommendation for use in such cases 1. When considering the treatment of complicated UTIs, it's essential to prioritize the most recent and highest quality evidence. The 2022 guidelines from the European Society of Clinical Microbiology and Infectious Diseases recommend carbapenems, such as meropenem, as targeted therapy for patients with bloodstream infections and severe infections due to 3GCephRE 1.
Key Considerations
- The choice of carbapenem should be based on the severity of the infection, local resistance patterns, and specific host factors, such as allergies.
- Initial empiric therapy often includes carbapenems, with meropenem being a preferred option due to its broad-spectrum activity and strong recommendation for use.
- Treatment duration should be tailored to the individual patient, with a typical range of 7-14 days, depending on the severity of the infection and the patient's response to therapy.
- Source control, including removal or exchange of urinary catheters and drainage of any abscesses, is crucial in managing complicated UTIs.
- Follow-up cultures should be performed to ensure infection clearance, and adjustments to the treatment regimen should be made as needed based on the results of susceptibility testing.
Additional Options
- Other carbapenems, such as ertapenem, may be considered in certain cases, but meropenem remains the preferred option due to its strong recommendation for use and broad-spectrum activity.
- For patients with carbapenem-resistant organisms, alternative options, such as ceftazidime-avibactam or meropenem-vaborbactam, may be considered, often in combination with other agents, such as polymyxins or aminoglycosides.
- The 2024 guidelines from the European Association of Urology emphasize the importance of appropriate management of the underlying urological abnormality and the use of antimicrobial therapy tailored to the specific pathogen and local resistance patterns 1.
From the FDA Drug Label
- 4 Complicated Urinary Tract Infections Including Pyelonephritis Ertapenem for injection is indicated for the treatment of adult patients and pediatric patients (3 months of age and older) with complicated urinary tract infections including pyelonephritis due to Escherichia coli, including cases with concurrent bacteremia, or Klebsiella pneumoniae.
The recommended Carbapenem for complicated urinary tract infections (UTIs) due to resistant organisms is Ertapenem.
- Key points:
- Ertapenem is indicated for the treatment of complicated UTIs, including pyelonephritis.
- It is effective against Escherichia coli and Klebsiella pneumoniae, which are common causes of UTIs.
- Ertapenem should be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2.
From the Research
Carbapenem Options for UTIs
- The choice of carbapenem for treating urinary tract infections (UTIs) depends on various factors, including the causative organism, local resistance patterns, and patient-specific factors 3, 4, 5, 6.
- Meropenem/vaborbactam is a recommended option for complicated UTIs, especially those caused by carbapenem-resistant uropathogens 5, 6.
- Ertapenem is another carbapenem option for UTIs, with a broad spectrum of activity against many Gram-positive and Gram-negative aerobes and anaerobes 4.
- Other carbapenem options, such as imipenem/cilastatin and doripenem, may also be effective, but their use may be limited by resistance patterns and side effect profiles 5.
Comparison of Carbapenems
- A network meta-analysis comparing different carbapenems for complicated UTIs found that meropenem/vaborbactam had higher clinical and microbiological treatment success rates than other carbapenems, but also had a higher risk of adverse events 5.
- Ertapenem and biapenem were also found to have high treatment success rates, while doripenem had lower clinical treatment success rates than other carbapenems 5.
Newer Options
- Sulopenem is a newer penem antibiotic that has shown promise in treating UTIs, including those caused by multidrug-resistant bacteria 7.
- Sulopenem has a broad spectrum of activity against many Gram-positive and Gram-negative aerobes and anaerobes, and has been shown to be effective in animal models of infection 7.
- However, more clinical data are needed to fully assess the efficacy and safety of sulopenem for UTIs, especially in patients with complicated infections caused by resistant pathogens 7.