ESBL 양성 대장균, 급성 방광염, 경구 항생제 선택

 

20대/F

C/C Urinary frequency, urgency for 2 days

ROS No fever

Impression ) Acute cystitis

Rx) Fosfomycin 3 g (empirical antibiotics)

 

 

 

 

증상은 급성 방광염, 소변검사와 배양검사에서 이에 상응하는 결과와 ESBL positive E.coli가 확인되었으며 증상이 호전되었다면 추가 치료는 필요하지 않습니다. 간혹 ESBL positive E.coli가 배양되었으므로 항생제 주사 치료가 필요하다는 내용의 의뢰서를 보기는 하지만 이 예의 경우에는 carbapenem 항생제가 필요하지 않습니다.

For patients who have risk factors for an MDR gram-negative infection, we first obtain urine culture and susceptibility testing. For empiric treatment, oral options include nitrofurantoin monohydrate/macrocrystals (Macrobid, 100 mg orally twice daily for five days), fosfomycin (3 grams of powder mixed in water as a single dose), or, if available, pivmecillinam (400 mg orally three times daily for three to five days), unless the patient has a history of an isolate with documented resistance to these agents in the prior three months. If all these are appropriate options based on patient circumstances (allergies, intolerances, drug interactions) and prior urinary isolates, we suggest nitrofurantoin. We favor reserving the use of fosfomycin for documented MDR gram-negative infections or when nitrofurantoin is not an option, and pivmecillinam is not as effective. In the United States, resistance to all oral options is still uncommon among outpatients with E. coli cystitis. Studies have suggested that nitrofurantoin, fosfomycin, and pivmecillinam still retain clinical activity against some MDR organisms, including ESBL-producing isolates. As an example, in a case-control study including 113 patients with ESBL-producing E. coli UTIs, no resistance to fosfomycin was detected and clinical cure rates were high (93 percent). Some studies have evaluated a higher dose of fosfomycin (eg, 3 g once every 2 to 3 days for 3 doses) for infections due to MDR organisms, but there is no evidence that this has greater efficacy than single-dose therapy. REF. UpToDate 2022.04.18