Temocillin versus carbapenems for urinary tract infection due to ESBL-producing Enterobacteriaceae: a multicenter matched case-control study.

ABSTRACT Objectives : We aim to compare the efficacy of temocillin to carbapenems for ESBL-E UTI. Methods : We conducted a multicenter retrospective case-control study of adults with ESBL-E UTI between January-2015 and October-2019. Cases received temocillin ≥50% of the effective antibiotic therapy duration. Control exclusively received carbapenem. They were statistically matched (1:1 ratio) on period, sex, and age. The clinical cure at the end of antibiotic therapy was analyzed using conditional logistic regression. Results : We matched 72 temocillin cases to 72 carbapenem controls. Most (67%) were male, aged 69.4-years in median, 81 (56%) were immunocompromised, including 44 (31%) solid organ transplant recipients (SOT). There was no difference between cases and controls for baseline characteristics and microorganisms involved: K.pneumoniae in 59 (41%), E.coli in 57 (40%), and Enterobacter spp. in 24 (17%). The median time from admission to effective antibiotic therapy was 0-days [0-2]. Among cases, first-line antibiotic therapy (≤72 hours) was temocillin in 6 (8%) and carbapenems in 39 (54%). Temocillin was given at the median daily dose of 4g [2] , [3] , [4] , after 3-days [2] , [3] , [4] , [5] of carbapenems. Patients received temocillin for 81% [70-93] of the effective antibiotic course duration during 11-days [8] , [9] , [10] , [11] , [12] , [13] , [14] . The effective antibiotic duration was similar in cases and controls (p-value=0.067). Clinical cure at the end of the antibiotic therapy was 94% (68/72) in cases versus 99% (71/72) in controls (p-value=0.206), without difference among immunocompromised and SOT patients (p-value>0.050). Conclusions : Temocillin effectively relays beta-lactams, including carbapenems, to treat (complicated) ESBL-E UTI. Its efficacy is consistent among kidney transplant recipients.