Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection-- 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials.

J Antimicrob Chemother. 2013 May 21;

Authors: Eliakim-Raz N, Yahav D, Paul M, Leibovici L

Abstract
BACKGROUND: Acute pyelonephritis is a frequent cause of morbidity, with a wide variation in duration of therapy. We performed a systematic review of all randomized controlled trials (RCTs) comparing ≤7 days treatment with a longer course. METHODS: Electronic databases were searched to identify RCTs that assessed adults treated for pyelonephritis, comparing a 7 day or shorter versus longer therapy. Primary outcome was clinical failure at the end of the long treatment arm (EOT). Secondary outcomes included clinical failure at the end of follow-up (EOF), microbiological failure, all-cause mortality, the development of resistance and adverse events. RESULTS: Clinical failure at EOT did not significantly differ between the two treatment arms [relative risk (RR) 0.63, 95% CI 0.33-1.18, I² = 41%]. Results did not differ when including studies comparing only fluoroquinolones, reducing the heterogeneity (RR 0.76, 95% CI 0.49-1.17, I² = 0%). We found no difference between the short and long treatment arms regarding clinical failure at EOF, even in a small subgroup of bacteraemic patients. No difference was found between the arms regarding microbiological failure at EOF, except in a subgroup of studies with a high percentage of patients with urogenital abnormalities, where microbiological failure at EOF was significantly higher in the short treatment arm (RR 1.78, 95% CI 1.02-3.10, I(2) = 21%). Adverse events were similar between the arms. CONCLUSIONS: Seven days of treatment for acute pyelonephritis is equivalent to longer treatment in terms of clinical failure and microbiological failure, including in bacteraemic patients. In patients with urogenital abnormalities, the evidence, although weak, suggests that longer treatment is required.

PMID: 23696620 [PubMed - as supplied by publisher]

A breach in patients' safety in randomized controlled trials of antibiotic drugs.

J Antimicrob Chemother. 2013 May 9;

Authors: Leibovici L, Paul M

Abstract
In a number of randomized controlled trials of antibiotic drugs the pathogens cultured from patients and their in vitro susceptibilities to the study drugs were not disclosed to the physicians during the whole course of the disease. These trials included patients with sepsis and bacteraemia. In clinical practice the information on the pathogen and its susceptibilities serves to re-evaluate the antibiotic treatment on the second or third day. As there is strong evidence that antibiotic treatment (empirical and definitive) matching the in vitro susceptibility of the pathogen reduces fatality rates in severe infections, withholding these data is a breach in patient safety. Sponsors and investigators of clinical trials of antibiotic drugs should ensure that the susceptibility of pathogens to the trial drugs are made available to clinicians in real time and taken into account when considering change in patient management, as would be the case in routine clinical practice. Members of research ethics committees should make sure that the protocols provide for this, while journals considering publication of clinical trial results should ask that details on the availability of susceptibilities to the trial antibiotics are disclosed in the methods section.

PMID: 23661594 [PubMed - as supplied by publisher]

Antimicrobial susceptibility of 22746 pathogens from Canadian hospitals: results of the CANWARD 2007-11 study.

J Antimicrob Chemother. 2013 May;68 Suppl 1:i7-i22

Authors: Zhanel GG, Adam HJ, Baxter MR, Fuller J, Nichol KA, Denisuik AJ, Lagacé-Wiens PR, Walkty A, Karlowsky JA, Schweizer F, Hoban DJ, Canadian Antimicrobial Resistance Alliance (CARA)

Abstract
OBJECTIVES: The purpose of the CANWARD study was to assess the antimicrobial activity of a variety of available agents against 22 746 pathogens isolated from patients in Canadian hospitals between 2007 and 2011.
METHODS: Between 2007 and 2011, 27 123 pathogens were collected from tertiary-care centres from across Canada; 22 746 underwent antimicrobial susceptibility testing using CLSI broth microdilution methods. Patient demographic data were also collected.
RESULTS: Of the isolates collected, 45.2%, 29.6%, 14.8% and 10.4% were from blood, respiratory, urine and wound specimens, respectively. Patient demographics were as follows: 54.4%/45.6% male/female, 12.8% ≤17 years old, 45.1% 18-64 years old and 42.1% ≥65 years old. Isolates were obtained from patients in medical and surgical wards (37.8%), emergency rooms (25.7%), clinics (18.0%) and intensive care units (18.5%). The three most common pathogens were Escherichia coli (20.1%), Staphylococcus aureus [methicillin-susceptible S. aureus and methicillin-resistant S. aureus (MRSA)] (20.0%) and Pseudomonas aeruginosa (8.0%), which together accounted for nearly half of the isolates obtained. Susceptibility rates (SRs) for E. coli were 100% meropenem, 99.9% tigecycline, 99.7% ertapenem, 97.7% piperacillin/tazobactam, 93.7% ceftriaxone, 90.5% gentamicin, 77.9% ciprofloxacin and 73.4% trimethoprim/sulfamethoxazole. Twenty-three percent of the S. aureus were MRSA. SRs for MRSA were 100% daptomycin, 100% linezolid, 100% telavancin, 99.9% vancomycin, 99.8% tigecycline, 92.2% trimethoprim/sulfamethoxazole and 48.2% clindamycin. SRs for P. aeruginosa were 90.1% amikacin, 93.1% colistin, 84.0% piperacillin/tazobactam, 83.5% ceftazidime, 82.6% meropenem, 72.0% gentamicin and 71.9% ciprofloxacin.
CONCLUSIONS: The CANWARD surveillance study has provided important data on the antimicrobial susceptibility of pathogens commonly causing infections in Canadian hospitals.

PMID: 23587781 [PubMed - in process]