Treatment only by or in close collaboration with infectious-disease specialist.
Aggressive source control is vital (removal of urine catheters, repeated drainage of abcesses, etc)
all MIC’s should be confirmed by e-testing, not only by Vitek.
Urinary tract infections
Uncomplicated cystitis: fosfomycin 3 gram single dose oral, if sensitive. Otherwise: gentamicin monotherapy (see 2) 7-14 days
Complicated urinary tract infection, not acutely ill: fosfomycin oral every 2 days OR gentamicin monotherapy, if sensitive. 7-14 days, with the shortest possible course when using gentamicin to avoid nephrotoxicity. Otherwise: see 3
If colistine R: meropenem + ertapenem (independent of meropenem MIC) + (give 1 of 2 options) gentamycine OR rifampicin. NB Double carbapenem dosing gives higher risk of seizures.
Doses: (everything iv, except fosfomycine/rifampicin)
meropenem 3x2 gram, 4 hours per infusion. (put: ‘vertraagde infusie’, call hospital pharmacist and put on prescription who you talked to)
GFR 20-50: 2x2 gram, delayed infusion
GFR 10-20: 1x2 gram, delayed infusion
Hemodialysis: 1x2grams, delayed infusion. Dose after dialysis if dialysed that day
If trough levels > 1 mg/l: raise dosing interval, do not lower total dose (that will only decrease the therapeutic effect) (Petrosillo, expert reviews 2014)
Renal failure: dosing in accordance with hospital pharmacyst/nephrologist.
General comments
Cystitis / Urineweginfectie - Carbapenem Resistente Enterobacteriaceae
General remarks:
Urinary tract infections
Doses: (everything iv, except fosfomycine/rifampicin)