837. Clinical Success in Outpatient Treatment of Complicated Urinary Tract Infections (UTI) with Ertapenem
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Ertapenem in UTI Poster#837_IDWeek 2013.pdf (422.1 kB)
  • Background: Resistant pathogens are increasingly common in patients (pts) experiencing UTIs and rapid administration of appropriate antibiotics is vital to achieving success.  A physician office infusion center (POIC) offers an ideal setting and once daily ertapenem, with a wide gram negative spectrum is an ideal agent.  The study purpose was to evaluate therapy and outcomes of UTI pts receiving ertapenem in a POIC.

    Methods: A retrospective database review was conducted of 4 Infectious Disease POICs for adult pts receiving ertapenem therapy for UTI between July 1, 2010 and December 31, 2012.  75 pts with a UTI diagnosis and available culture data were randomly selected from each site.  Data collected included age, gender, diagnosis, presence of urinary catheter, history of UTI, microbiology, duration of treatment, and adverse events.  Clinical success was defined as cure, either microbiological or clinical plus improvement, defined as partial resolution or added antibiotics at the completion of ertapenem therapy. Failure was defined as inadequate response, worsening of infection or need for a change in antibiotic. 

    Results: Mean age was 65 yrs with 72% males.  Pyelonephritis was present in 23% and bacteremia or urosepsis in 7%.  59% had a history of recurrent UTIs and 15% had a urinary catheter.  Common co-morbidities were hypertension (44%) and diabetes (28%).  ESBL Escherichia coli was the most common pathogen (51%), followed by non-ESBL Escherichia coli(24%).  Therapy was initiated in the POIC in 63%.  Mean treatment days, both inpatient and outpatient was 11 days, with 95% of total ertapenem received in the POIC.  Clinical success was achieved in 95% of pts (79% cured plus 16% improved), while 3 pts (4%) failed therapy and one pt was non-evaluable.  Therapy failures were all due to adverse events (AE) requiring discontinuation of ertapenem, with 1 pt seizure requiring hospitalization and 2 pts with anaphylactic type reactions.   Overall AEs occurred in 22 (29%) pts, most commonly diarrhea, occurring in 12%. Mild infusion reactions occurred in 5%. 

    Conclusion: Treatment of complicated UTIs with ertapenem achieved clinical success and was well tolerated.  With a high success rate in drug-resistant pathogens, ertapenem appears to be safe and effective in treatment of complicated UTIs in the POIC.

    Lucinda J. Van Anglen, PharmD1, Philip Brachman, MD, FACP, FIDSA2, Fernando S. Alvarado, MD, MPH & TM3 and Jennifer L. Christensen, PharmD, BCPS1, (1)Healix Infusion Therapy, Inc., Sugar Land, TX, (2)Atlanta ID Group, Atlanta, GA, (3)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL

    Disclosures:

    L. J. Van Anglen, Merck: Investigator, Research support

    P. Brachman, Gilead: Speaker's Bureau, Speaker honorarium
    Viiv: Speaker's Bureau, Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    Amgen: Speaker's Bureau, Speaker honorarium
    Jansen: Speaker's Bureau, Speaker honorarium

    F. S. Alvarado, Pfizer: Speaker's Bureau, Speaker honorarium

    J. L. Christensen, Merck: Collaborator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.