| アブストラクト | BACKGROUND: Flomoxef and cefmetazole have been reported to be effective against broad-spectrum beta-lactamase-producing bacteria and have gained attention as a potential alternative to carbapenems. This study aimed to compare the efficacy of these two drugs in treating urinary tract infection (UTI) by integrating in vitro data and two real-world databases. METHODS: The susceptibility rates of third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae to flomoxef and cefmetazole were compared using comprehensive national antimicrobial resistance surveillance data. Combined antimicrobial activities against an extended-spectrum beta-lactamase (ESBL)-producing multidrug-resistant bacterial strain were tested by diagonal measurement of n-way drug interactions. The effectiveness of the two drugs in treating UTIs was compared using hospital stay duration data obtained from the Japan Medical Data Center (JMDC) Claims Database. RESULTS: Third-generation cephalosporin-resistant E. coli and K. pneumoniae, including ESBL-producing strains, were similarly susceptible to flomoxef and cefmetazole. In vitro assessment against an ESBL-producing multidrug-resistant strain revealed similar antimicrobial interaction patterns. JMDC Claims data analysis showed that the median hospital stay was 11 (95% confidence interval [CI]: 11-11) and 4 (95% CI: 3-5) days in the cefmetazole and flomoxef groups, respectively (log-rank test, P < 0.001). Moreover, the flomoxef group demonstrated a significantly lower frequency of adverse events such as C. difficile infection and renal failure. CONCLUSIONS: The effectiveness of flomoxef is comparable to that of cefmetazole in treating UTIs without major complications. Thus, flomoxef is a viable treatment option for UTIs in locales with a high prevalence of ESBL-producing strains. |
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| 投稿者 | Niimura, Takahiro; Goda, Mitsuhiro; Nakano, Satoshi; Kajihara, Toshiki; Yahara, Koji; Hirabayashi, Aki; Miyata, Koji; Ikai, Marie; Shinohara, Motoko; Minato, Yusuke; Suzuki, Masato; Ishizawa, Keisuke |
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| 組織名 | Department of Clinical Pharmacology and Therapeutics, University of Tokushima;Graduate School of Biomedical Sciences, Tokushima, Japan.;Clinical Research Center for Developmental Therapeutics, Tokushima University;Hospital, Tokushima, Japan.;Department of Clinical Pharmacology and Therapeutics, Graduate School of;Biomedical and Heath Sciences, Hiroshima University, Hiroshima, Japan.;Antimicrobial Resistance Research Center, National Institute of Infectious;Diseases, Japan Institute for Health Security, Tokyo, Japan.;Center for Infectious Disease Research, Fujita Health University, Aichi, Japan.;yusuke.minato@fujita-hu.ac.jp.;Diseases, Japan Institute for Health Security, Tokyo, Japan. suzuki-m@niid.go.jp.;ishizawa@tokushima-u.ac.jp.;Hospital, Tokushima, Japan. ishizawa@tokushima-u.ac.jp.;Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan. |
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