Comparison of clinical outcome between β-lactam/β-lactamase inhibitor (BLBLI) and carbapenem for treatment of extended-spectrum β-lactamase (ESBL) urinary tract infection

Objective: The aim of this study was to compare the outcomes between beta-lactam/beta-lactamase inhibitor combinations (BLBLI) and carbapenem for the treatment of extended-spectrum beta-lactamase (ESBL)-producing Enterobactaeriacae urinary tract infections (UTI). Design: Retrospective study Setting: Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia Subjects: A total of 79 patients with ESBL-producing Enterobactaeriacae urinary tract infection between January 2015 and December 2017 that fulfill inclusion and exclusion criteria were eligible in this study. Intervention: Medical records of all the patients were reviewed and the data were collected retrospectively. Main outcome measures: Clinical and microbiological outcomes were evaluated in a retrospective study of patients with ESBL-producing Enterobactaeriacae UTI from a tertiary center in Malaysia. Demographic data, clinical and microbiological characteristics, and outcomes in patients received definitive therapy with BLBLI and carbapenem were compared. Further analysis was done by controlling the confounders using multiple logistic regression. Results: Clinical failure rate for those treated with BLBLI vs. carbapenem were 18.8% (6/32) vs. 23.4% (11/47) respectively. After adjusting for the confounders, the only significant risk factors for clinical failure were severe sepsis or septic shock at presentation (OR: 21.812; 95% CI: 3.735, 127.373; P=0.001), presence of external catheter (OR: 9.741; 95% CI: 1.720, 55.162; P=0.010), and presence of other concomitant infection (OR: 5.168; 95% CI: 1.272, 20.990; P=0.022). Empirical and definitive treatment with BLBLI were not associated with increased risk of clinical failure. Conclusion: BLBLI was non-inferior to carbapenem for treatment of ESBL-producing Enterobactaeriacae UTI.