Retrospective Assessment of the Treatment Effectiveness of β-lactam/β-lactamase Inhibitor and Carbapenem Groups Antibiotics in Upper Urinary Tract Infections Caused by Extended Spectrum β-lactamase Producing Escherichia coli and Klebsiella Pneumoniae

Aim: The rate of infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria is increasing globally. The resistance problem, which has spread especially since the 21(st) century, has led to an increase in the use of carbapenem group antibiotics in clinical cases of upper urinary tract infection (UUTI) caused by these bacteria. In this process, the increase in the number of bacteria, including carbapenemase-producing bacteria, and the slowly developing new antibiotic processes have led experts to different antibiotic therapies. In light of this situation, current evidence regarding the effectiveness of beta-lactam/beta-lactamase inhibitors (BL/BLI), which are considered an effective treatment alternative for UUTI due to ESBL-producing Enterobacterales, is still controversial. The aim of this study is to determine the effectiveness of BL/BLI versus carbapenems in the treatment of UUTI due to ESBL-producing Enterobacterales. Materials and Methods: Our study included 176 patients diagnosed with UUTI caused by ESBL-producing Escherichia coli(E. coli) and Klebsiella pneumoniae (K. pneumoniae) and treated with carbapenem or BL/BLI group antibiotics. Patients' age, gender, underlying diseases, biochemical test results, isolated microorganism and their antibiotic susceptibility, immunosuppressive therapy in the last month, accompanying bacteremia, complicating factors, having UUTI in the last year, a history of using antibiotics in the last 3 months, and a history of hospitalization admission were recorded. Results: In patient distribution, carbapenem was used in the treatment of 99(56.2%) patients and BL/BLI treatment was used in 77(43.7%) patients. The mean age of the patients was 66.81 +/- 13.82 (years), 107 (60.8%) patients were in the >= 65 age group and 88 (50%) patients were female. It was found that 79 (45%) of the patients had malignancy and 75 (42.6%) received immunosuppressive treatment. No statistically significant difference was found in clinical response and treatment outcomes (7(th), 14(th) and 30(th) day mortality) between the groups receiving specific treatment (p>0.05). Conclusion: BL/BLI (piperacillin-tazobactam) may be an effective alternative to carbapenems in the treatment of UTI due to ESBL-producing E. coli or K.pneumoniae.