From the Guidelines
For treating ESBL-producing bacteria in urinary tract infections, intravenous fosfomycin is a recommended treatment option, especially for patients without septic shock, with or without bacteraemia, as shown in the ZEUS and FOREST trials 1.
Treatment Options
- Intravenous fosfomycin can be used as an alternative to carbapenems, with high-certainty evidence supporting its effectiveness in treating complicated urinary tract infections (cUTI) caused by ESBL-producing Enterobacterales 1.
- Aminoglycosides, such as amikacin, can also be considered for short durations of therapy, but with moderate certainty of evidence and a higher risk of nephrotoxicity 1.
- Carbapenems, such as meropenem or ertapenem, are still recommended as first-line treatment options for severe infections or septic shock, with strong recommendations for use and moderate certainty of evidence 1.
Important Considerations
- Treatment should always be guided by susceptibility testing, as resistance patterns can vary 1.
- Patients should complete the full course of antibiotics, even if symptoms improve quickly, to ensure eradication of the infection.
- Increased fluid intake can help flush bacteria from the urinary tract, and follow-up urine cultures may be necessary to confirm eradication of the infection.
- Healthcare providers should consider risk factors for ESBL infections, including recent hospitalization, prior antibiotic use, and advanced age, when selecting empiric therapy 1.
From the FDA Drug Label
Among Gram-negative uropathogens from both arms of Trial 2, genotypic testing identified certain ESBL groups (e.g., TEM-1, SHV-12, CTX-M-15, CTX-M-27, KPC-2, KPC-3, OXA-48) and AmpC beta-lactamases expected to be inhibited by avibactam in isolates from 273/281 (97.2%) patients in the mMITT population.
ESBL-producing organisms in urine can be treated with avibactam, as it has been shown to inhibit certain ESBL groups, including TEM-1, SHV-12, CTX-M-15, and others. The clinical and microbiological cure rates in patients with ESBL-producing organisms were similar to the overall results, suggesting that avibactam is effective against these organisms 2.
From the Research
ESBL in Urine Antibiotics
- The use of different antibiotics to treat urinary tract infections (UTIs) can lead to the development of antimicrobial resistance, including the production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae 3.
- ESBL-producing Enterobacteriaceae are often multidrug resistant, making treatment challenging, but studies have shown that certain antibiotics such as pivmecillinam, fosfomycin, and nitrofurantoin may be effective against these organisms 3, 4.
- A study found that more than 95% of ESBL-producing Enterobacteriaceae were sensitive to pivmecillinam, fosfomycin, and nitrofurantoin, making these antibiotics potential treatment options for uncomplicated UTIs caused by these organisms 3.
- Amoxicillin-clavulanic acid (AMC) has also been shown to be effective in treating UTIs caused by ESBL-producing organisms, particularly those with low minimum inhibitory concentrations (MICs) of AMC 5.
- However, the development of resistance to AMC during therapy is a concern, particularly in organisms with high AMC MICs 5.
- The duration of treatment for complicated UTIs caused by ESBL-producing Enterobacteriaceae is also an important consideration, with studies suggesting that short courses of antimicrobial treatment (≤ 7 days) may be effective in some cases 6.
- In cases where intravenous antibiotics are initially required, switching to oral antibiotics such as AMC may be a viable option, as shown in a study where two children with ESBL-UTI were successfully treated with AMC after initial intravenous therapy 7.