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Clinical Studies of Cefpirome in the Treatment of Urinary Tract Infections Caused by Enterococcus faecalis
Clinical Studies of Cefpirome in the Treatment of Urinary Tract Infections Caused by Enterococcus faecalis Tetsuro Matsumoto, Joichi Kumazawa, Yorio Naide, and Masaki Horiba
INTRODUCTION Cefpirome (CPR) was launched more than 3 years ago in Japan. We evaluated the clinical and bacteriologic response of Enterococcus faecalis isolates treated with CPR and investigated the presence or absence of trends toward drug resistance.
MATERIALS AND METHODS During the period June 1994 to May 1996 the clinical effectiveness, bacteriologic response, and chronologic shifts of sensitivity of E. faecalis to CPR was studied in 56 patients with complicated urinary tract infections (UTIs) considered to be caused by E. faecalis. Inclusion criteria were pyuria before treatment of $5 WBC/hpf and bacteriuria $104 CFU/mL. Eight patients were excluded because of pyuria less than 5 WBC/hpf and bacteriuria less than 104 CFU/ mL, concomitant use of another antibiotic or funguria. Forty-eight patients (34 males and 14 females) were evaluated for the clinical efficacy of CPR. Fourteen patients had long-term indwelling catheters. Fourteen patients had complicated pyelonephritis, and 34 patients had complicated cystitis. Patients received i.v. 0.5 or 1 g of CPR twice daily for more than 5 days. All cases were evaluated by From the Department of Urology, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan, Department of Urology, Faculty of Medicine, Kyushu University, Fukuoka, Japan, and Department of Urology, Fujita Health University School of Medicine, Toyoaki, Japan. Address reprint requests to Dr. Tetsuro Matsumoto, Department of Urology, University of Occupational and Environmental Health Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan. Received 20 January 1998; accepted 12 February 1998.
DIAGN MICROBIOL INFECT DIS 1998;30:497–498 © 1998 Elsevier Science Inc. All rights reserved. 655 Avenue of the Americas, New York, NY 10010
response of bacteriuria and pyuria on the fifth day according to Japanese UTI criteria such as excellent, moderate, and poor (Ohkoshi 1987). Minimal inhibition concentrations (MICs) of E. faecalis to CPR, ceftazidime, piperacillin, cefpiramide, and ofloxacin were measured by Japanese standard method (Report of CJSASTB, 1990). MIC distribution of E. faecalis to CPR was compared to the results obtained from isolates in other time periods of 1987–1989.
RESULTS AND DISCUSSION E. faecalis was identified in 30 patients, 12 of whom had single-organism infections and 18 had mixed TABLE 1. Bacteriological Response to Cefpirome of Enterococcus faecalis and Other Species Isolates
Eradicated Persisted
Eradication rate (%)
Enterococcus faecalis (isolated from single infection) (isolated from mixed infection) Total
11
1
91.7
17 28
1 2
94.4 93.3
Staphylococcus spp. other GPCa Escherichia coli Citrobacter freundii Enterobacter spp. Pseudomonas spp. other GNRb Total
7 2 11 3 3 7 9 42
0 0 0 0 0 4 1 5
100 100 100 100 100 63.6 90.0 89.4
a b
GPC, Gram-positive cocci GNR, Gram-negative rods.
0732-8893/98/$19.00 PII S0732-8893(98)00017-0
T. Matsumoto et al.
498 infections (Table 1). Overall rates of clinical efficacy were 100% and 83.3%, respectively, for single and mixed infection. We evaluated responses to treatment as excellent in 6 cases, moderate in 21 cases, and poor in 3 cases. The overall rate of efficacy among patients in whom E. faecalis was detected was 90% (27/30). The eradication rate of E. faecalis by CPR treatment was 93.3%. The MIC50 and MIC90 of the 30 strains of E. faecalis detected were 6.25 mg/mL and 25 mg/mL, respectively (Table 2). These were the same as the MIC50 and MIC90 of E. faecalis isolated in the period of 1987–1989 (Naide et al. 1991). Adverse side effects occurred in one patient, who experienced mild facial flush and pruritis. From these results, we concluded that the susceptibility of E. faecalis to CPR was no different in isolates in the two time periods of 1987–1989 and 1994 –
TABLE 2. MIC Distribution of Enterococcus faecalis to Various Drugs Antimicrobial Agent Cefpirome Ceftazidime Piperacillin Cefpiramide Ofloxacin Cefpirome (1987–1989)
MIC (mg/mL) Range
MIC50
MIC90
3.13–50 50–400 0.78–6.25 6.25–200 1.56–400
6.25 200 1.56 25 6.25
25 400 3.13 50 400
0.025–100
6.25
25
1996. Also, CPR was very useful for the treatment of complicated UTIs due to various kinds of bacteria, especially E. faecalis.
REFERENCES Naide Y, Kumamoto Y, Hirose T et al. (1991) Comparative study of cefpirome and ceftazidime in complicated urinary tract infections. Acta Urol Jpn 37:447–464. Ohkoshi M (1987) Criteria for evaluation of clinical efficacy
of antimicrobial agents on urinary tract infection. Jpn J Antibiot 40:2149–2191. Report of Committee for Japanese Standards for Antimicrobial Susceptibility Testing for Bacteria. (1990) Chemotherapy (Tokyo) 38:102–105.
INTRODUCTION Cefpirome (CPR) was launched more than 3 years ago in Japan. We evaluated the clinical and bacteriologic response of Enterococcus faecalis isolates treated with CPR and investigated the presence or absence of trends toward drug resistance.
MATERIALS AND METHODS During the period June 1994 to May 1996 the clinical effectiveness, bacteriologic response, and chronologic shifts of sensitivity of E. faecalis to CPR was studied in 56 patients with complicated urinary tract infections (UTIs) considered to be caused by E. faecalis. Inclusion criteria were pyuria before treatment of $5 WBC/hpf and bacteriuria $104 CFU/mL. Eight patients were excluded because of pyuria less than 5 WBC/hpf and bacteriuria less than 104 CFU/ mL, concomitant use of another antibiotic or funguria. Forty-eight patients (34 males and 14 females) were evaluated for the clinical efficacy of CPR. Fourteen patients had long-term indwelling catheters. Fourteen patients had complicated pyelonephritis, and 34 patients had complicated cystitis. Patients received i.v. 0.5 or 1 g of CPR twice daily for more than 5 days. All cases were evaluated by From the Department of Urology, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan, Department of Urology, Faculty of Medicine, Kyushu University, Fukuoka, Japan, and Department of Urology, Fujita Health University School of Medicine, Toyoaki, Japan. Address reprint requests to Dr. Tetsuro Matsumoto, Department of Urology, University of Occupational and Environmental Health Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan. Received 20 January 1998; accepted 12 February 1998.
DIAGN MICROBIOL INFECT DIS 1998;30:497–498 © 1998 Elsevier Science Inc. All rights reserved. 655 Avenue of the Americas, New York, NY 10010
response of bacteriuria and pyuria on the fifth day according to Japanese UTI criteria such as excellent, moderate, and poor (Ohkoshi 1987). Minimal inhibition concentrations (MICs) of E. faecalis to CPR, ceftazidime, piperacillin, cefpiramide, and ofloxacin were measured by Japanese standard method (Report of CJSASTB, 1990). MIC distribution of E. faecalis to CPR was compared to the results obtained from isolates in other time periods of 1987–1989.
RESULTS AND DISCUSSION E. faecalis was identified in 30 patients, 12 of whom had single-organism infections and 18 had mixed TABLE 1. Bacteriological Response to Cefpirome of Enterococcus faecalis and Other Species Isolates
Eradicated Persisted
Eradication rate (%)
Enterococcus faecalis (isolated from single infection) (isolated from mixed infection) Total
11
1
91.7
17 28
1 2
94.4 93.3
Staphylococcus spp. other GPCa Escherichia coli Citrobacter freundii Enterobacter spp. Pseudomonas spp. other GNRb Total
7 2 11 3 3 7 9 42
0 0 0 0 0 4 1 5
100 100 100 100 100 63.6 90.0 89.4
a b
GPC, Gram-positive cocci GNR, Gram-negative rods.
0732-8893/98/$19.00 PII S0732-8893(98)00017-0
T. Matsumoto et al.
498 infections (Table 1). Overall rates of clinical efficacy were 100% and 83.3%, respectively, for single and mixed infection. We evaluated responses to treatment as excellent in 6 cases, moderate in 21 cases, and poor in 3 cases. The overall rate of efficacy among patients in whom E. faecalis was detected was 90% (27/30). The eradication rate of E. faecalis by CPR treatment was 93.3%. The MIC50 and MIC90 of the 30 strains of E. faecalis detected were 6.25 mg/mL and 25 mg/mL, respectively (Table 2). These were the same as the MIC50 and MIC90 of E. faecalis isolated in the period of 1987–1989 (Naide et al. 1991). Adverse side effects occurred in one patient, who experienced mild facial flush and pruritis. From these results, we concluded that the susceptibility of E. faecalis to CPR was no different in isolates in the two time periods of 1987–1989 and 1994 –
TABLE 2. MIC Distribution of Enterococcus faecalis to Various Drugs Antimicrobial Agent Cefpirome Ceftazidime Piperacillin Cefpiramide Ofloxacin Cefpirome (1987–1989)
MIC (mg/mL) Range
MIC50
MIC90
3.13–50 50–400 0.78–6.25 6.25–200 1.56–400
6.25 200 1.56 25 6.25
25 400 3.13 50 400
0.025–100
6.25
25
1996. Also, CPR was very useful for the treatment of complicated UTIs due to various kinds of bacteria, especially E. faecalis.
REFERENCES Naide Y, Kumamoto Y, Hirose T et al. (1991) Comparative study of cefpirome and ceftazidime in complicated urinary tract infections. Acta Urol Jpn 37:447–464. Ohkoshi M (1987) Criteria for evaluation of clinical efficacy
of antimicrobial agents on urinary tract infection. Jpn J Antibiot 40:2149–2191. Report of Committee for Japanese Standards for Antimicrobial Susceptibility Testing for Bacteria. (1990) Chemotherapy (Tokyo) 38:102–105.