Clinical Significance and Optimal Treatment of Community-onset Urinary Tract Infections Caused by Extended-spectrum β-lactamase and/or AmpC β-lactamase Producing Enterobacteriaceae
Clinical Significance and Optimal Treatment of Community-onset Urinary Tract Infections Caused by Extended-spectrum β-lactamase and/or AmpC β-lactamase Producing Enterobacteriaceae
The purposes of this study are:

 1. To estimate the prevalence of extended spectrum β-lactamase (ESBL) and/or AmpC among
 Enterobacteriaceae which cause community-onset urinary tract infections (UTIs)

 2. To collect the background, risk factors and clinical outcome of patients with
 community-acquired uropathogenic condition related to Enterobacteriaceae (both ESBL,
 AmpC- and non ESBL and/or AmpC producing) after receive different antibiotic regimens.

 3. To develop a scoring system to early identify patients at risk of being infected with
 ESBL- and/or AmpC-producing Enterobacteriaceae by comparing the risk factors for
 community-onset UTIs caused by ESBL- and/or AmpC-positive against non ESBL -and/or AmpC
 Enterobacteriaceae

 4. To demonstrate the efficacy and safety of ertapenem for the empiric treatment of
 community-onset UTIs in patients at risk for ESBL- and/or AmpC-producing organism.

 The study hypothesis (i) Patients infected with community-acquired uropathogenic ESBL- and/or
 AmpC-producing Enterobacteriaceae who receive regimens other than carbapenems have a worse
 outcome.

 (ii) There are certain risk factors predicting the acquisition of community-onset UTIs caused
 by ESBL- and/or AmpC-producing Enterobacteriaceae.

 (iii) The use of ertapenem is an effective and safe empirical therapy compared with other
 agents for community-onset UTIs caused by ESBL- and/or AmpC-producing Enterobacteriaceae.
Inclusion Criteria:

 -  Adult patients who admitted to the Taipei Veterans General Hospital with the diagnosis
 of community-onset UTI caused by Enterobacteriaceae will be eligible for inclusion in
 this study if hospitalization for parental antimicrobial therapy is required

 Exclusion Criteria:

 -  pregnancy or lactation in women,

 -  history of serious allergy or intolerance to study drug therapy (patients with a
 history of mild rash to β-lactams could be enrolled),

 -  complete obstruction of the urinary tract,

 -  peri-nephritic or intrarenal abscess, prostatitis, any rapidly progressive disease or
 terminal illness,

 -  immuno-compromising illness or immuno suppression therapy, the need for concomitant
 antimicrobials in addition to study therapy,

 -  a baseline pathogen resistant to study drug,

 -  treatment with a systemic antimicrobial agent for >24 h within 72 h prior to
 enrolment, or absolute neutrophil count <1000/mm3.

 -  Men with a history or physical findings suggestive of acute or chronic prostatitis
 will also excluded.