Pharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tract

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dc.contributor.authorCuba, Gabriel Trova [UNIFESP]
dc.contributor.authorPignatari, Antonio Carlos Campos [UNIFESP]
dc.contributor.authorPatekoski, Katya Silva [UNIFESP]
dc.contributor.authorLuchesi, Lucimila Jorge [UNIFESP]
dc.contributor.authorKiffer, Carlos Roberto Veiga [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2015-06-14T13:47:15Z
dc.date.available2015-06-14T13:47:15Z
dc.date.issued2014-09-01
dc.description.abstractSince antimicrobial resistance among uropathogens against current first line agents has affected the management of severe urinary tract infection, we determined the likelihood that antibiotic regimens achieve bactericidal pharmacodynamic exposures using Monte Carlo simulation for five antimicrobials (ciprofloxacin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem) commonly prescribed as initial empirical treatment of inpatients with severe community acquired urinary tract infections. Minimum inhibitory concentration determination by Etest was performed for 205 Brazilian community urinary tract infection Escherichia coli strains from 2008 to 2012 and 74 E. coli bloodstream strains recovered from a surveillance study. Pharmacodynamic exposure was modeled via a 5000 subject Monte Carlo simulation. All isolates were susceptible to ertapenem and meropenem. Piperacillin/tazobactam, ceftriaxone and ciprofloxacin showed 100%, 97.5% and 83.3% susceptibility among outpatient isolates and 98.6%, 75.7% and 64.3% among inpatient isolates, respectively. Against outpatient isolates, all drugs except ciprofloxacin (82.7% in aggressive and 77.6% in conservative scenarios) achieved high cumulative fraction of response: car-bapenems and piperacillin/tazobactam cumulative fraction of responses were close to 100%, and ceftriaxone cumulative fraction of response was 97.5%. Similar results were observed against inpatients isolates for carbapenems (100%) and piperacillin/tazobactam (98.4%), whereas ceftriaxone achieved only 76.9% bactericidal cumulative fraction of response and ciprofloxacin 61.9% (aggressive scenario) and 56.7% (conservative scenario) respectively. Based on this model, standard doses of beta-lactams were predicted to deliver sufficient pharmacodynamic exposure for outpatients. However, ceftriaxone should be avoided for inpatients and ciprofloxacin empirical prescription should be avoided in both inpatients and outpatients with complicated urinary tract infection.en
dc.description.affiliationUniversidade Federal de São Paulo (UNIFESP) Department of Infectology Laboratório Especial de Microbiologia Clínica
dc.description.affiliationUnifespUNIFESP, Department of Infectology Laboratório Especial de Microbiologia Clínica
dc.description.sourceSciELO
dc.description.sponsorshipMerck Sharp & Dohme
dc.format.extent512-517
dc.identifierhttp://dx.doi.org/10.1016/j.bjid.2014.01.008
dc.identifier.citationBrazilian Journal of Infectious Diseases. Brazilian Society of Infectious Diseases, v. 18, n. 5, p. 512-517, 2014.
dc.identifier.doi10.1016/j.bjid.2014.01.008
dc.identifier.fileS1413-86702014000500512.pdf
dc.identifier.issn1413-8670
dc.identifier.scieloS1413-86702014000500512
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/8557
dc.identifier.wosWOS:000346072300009
dc.language.isoeng
dc.publisherBrazilian Society of Infectious Diseases
dc.relation.ispartofBrazilian Journal of Infectious Diseases
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectPharmacodynamicsen
dc.subjectMonte Carlo methoden
dc.subjectEscherichia colien
dc.subjectUrinary tract infectionen
dc.titlePharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tracten
dc.typeinfo:eu-repo/semantics/article
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