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. 2016 Nov 3;16(1):620.
doi: 10.1186/s12879-016-1797-3.

Characteristics of gram-negative urinary tract infections caused by extended spectrum beta lactamases: pivmecillinam as a treatment option within South Dublin, Ireland

Fardod O'Kelly  1 , Siobhan Kavanagh  2 , Rustom Manecksha  1 , John Thornhill  1 , Jérôme P Fennell  3
Affiliations

Characteristics of gram-negative urinary tract infections caused by extended spectrum beta lactamases: pivmecillinam as a treatment option within South Dublin, Ireland

Fardod O'Kelly et al. BMC Infect Dis. .

Abstract

Background: The prevalence of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing and the therapeutic options are limited, especially in primary care. Recent indications have suggested pivmecillinam to be a suitable option. This pilot study aimed to assess the viability of pivmecillinam as a therapeutic option in a Dublin cohort of mixed community and healthcare origin.

Methods: A prospective measurement of mean and fractional inhibitory concentrations of antibiotic use in 95 patients diagnosed with UTI caused by ESBL-producing Enterobacteriaceae was carried out. 36 % patients were from general practice, 40 % were admitted to hospital within south Dublin, and 25 % samples arose from nursing homes. EUCAST breakpoints were used to determine if an isolate was sensitive or resistant to antibiotic agents.

Results: Sixty-nine percent of patients (N = 66) with urinary ESBL isolates were female. The mean age of females was 66 years compared with a mean age of 74 years for males. Thirty-six percent of isolates originated from primary care, hospital inpatients (26 %), and nursing homes (24 %). The vast majority of ESBL isolates were E. coli (80 %). The E tests for mecillinam and co-amoxiclav had concentration ranges from 0.16 mg/L up to 256 mg/L. The mean inhibitory concentration (MIC) of mecillinam ranged from 0.25 to 256 mg/L, while co-amoxiclav MICs ranged from 6 to 256 mg/L. The percentage of isolates resistant to mecillinam and co-amoxiclav was found to be 5.26 and 94.74 % respectively.

Conclusions: This is the first study exploring the use of pivmecillinam in an Irish cohort and has demonstrated that its use in conjunction with or without co-amoxiclav is an appropriate and useful treatment for urinary tract infections caused by ESBL-producing organisms.

Keywords: Antibiotic resistance; Escherichia coli; Extended-spectrum beta lactamase; Mean inhibitory concentration; Pivmecillinam; Urinary tract infection.

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Figures

Fig. 1
Fig. 1
Distribution of the mean inhibitory concentration (MIC) of 95 Extended spectrum beta-lactamase (ESBL) producing isolates. EUCAST break-point of 8 mg/L demonstrated by red vertical line
Fig. 2
Fig. 2
Distribution of the mean inhibitory concentration (MIC) of 95 Extended spectrum beta-lactamase (ESBL) producing isolates. EUCAST break-point of 8 mg/L demonstrated by red vertical line
See this image and copyright information in PMC

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