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Aktuelle Urol 2017; 48(03): 243-247
DOI: 10.1055/s-0043-102153
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

In-vitro-Aktivität von Mecillinam gegen Escherichia coli: Urinisolate von Patienten im niedergelassenen Versorgungsbereich in Deutschland

In-vitro activity of mecillinam against urine isolates of Escherichia coli from outpatient departments in Germany
Michael Kresken
1   Antiinfectives Intelligence GmbH, Rheinbach
2   Rheinische Fachhochschule Köln gGmbH
,
Barbara Körber-Irrgang
1   Antiinfectives Intelligence GmbH, Rheinbach
,
Kurt G. Naber
3   Technische Universität München
› Author Affiliations
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Publication History

Publication Date:
20 April 2017 (online)

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Zusammenfassung

Die Behandlung der akuten unkomplizierten Zystitis soll entsprechend nationaler und internationaler Leitlinien primär mit Fosfomycin-Trometamol, Nitrofurantoin, Nitroxolin oder Pivmecillinam erfolgen. Die weitaus meisten ambulant erworbenen Harnwegsinfektionen werden durch Escherichia coli verursacht. Pivmecillinam (X-SYSTO®) ist das oral verfügbare Prodrug des Penicillin-Derivats Mecillinam, das seit März 2016 wieder auf dem deutschen Markt zur Verfügung steht. Das Ziel der Studie war, den Anteil der Mecillinam-resistenten Stämme bei E. coli-Isolaten vor der Einführung von X-SYSTO® in Deutschland zu ermitteln.

Im Rahmen einer In-vitro-Studie wurden die minimalen Hemmkonzentrationen (MHK) von Mecillinam für 494 E.-coli-Urinisolate (einschließlich multiresistenter Stämme) bestimmt. Die Bakterienisolate waren im Zeitraum Oktober bis Dezember 2013 in 25 Laboren von Patienten aus dem niedergelassenen Bereich gesammelt worden. Die Bewertung der Erregerempfindlichkeit als Mecillinam-sensibel (MHK ≤ 8 mg/l) bzw. resistent (MHK > 8 mg/l) erfolgte mithilfe der Grenzwerte des European Committee on Antimicrobial Susceptibility Testing (EUCAST).

Die Konzentrationen von Mecillinam, die zur Hemmung von 50 % bzw. 90 % der getesteten Isolate benötigt wurden, betrugen 1 und 4 mg/l für Isolate mit dem Extended-Spektrum-β-Laktamase-Phänotyp und 0,25 und 4 mg/l für die übrigen Isolate. Insgesamt wurden 98 % der Isolate als Mecillinam-sensibel und 2 % als resistent bewertet.

Die Ergebnisse stützen die Empfehlung, Pivmecillinam als eine primäre Option zur Erstlinientherapie der akuten unkomplizierten Zystitis zu betrachten.

Summary

National and international guidelines recommend fosfomycin trometamol, nitrofurantoin, nitroxoline, and pivmecillinam as first-line agents for the treatment of acute uncomplicated cystitis. Escherichia coli is by far the leading cause of community-acquired urinary tract infections. Pivmecillinam (X-SYSTO®) is an oral prodrug of mecillinam, a penicillin derivative that was reintroduced to the German market in March 2016. This study aimed to investigate the proportion of mecillinam-resistant strains among E. coli isolates prior to the introduction of X-SYSTO® in Germany.

An in-vitro study was carried out to determine the minimal inhibitory concentrations (MICs) of mecillinam against 494 urine isolates of E. coli (including multidrug-resistant strains). Isolates were obtained from outpatients and collected in 25 laboratories between October and December 2013. MIC breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied for classifying the bacterial isolates as mecillinam-susceptible (MIC ≤ 8 mg/l) or resistant (MIC > 8 mg/l).

The concentrations of mecillinam needed to inhibit 50 % and 90 % of the test isolates were 1 and 4 mg/l, respectively, for isolates displaying the extended spectrum β-lactamase phenotype, and 0.25 and 4 mg/l, respectively, for the remaining isolates. Overall, 98 % of the isolates were found to be mecillinam-susceptible (MIC ≤ 8 mg/l), and 2 % were found to be resistant (MIC > 8 mg/l).

These findings support the recommendation to regard pivmecillinam as a first-line option for the treatment of acute uncomplicated cystitis.

Schlüsselwörter

Escherichia coli - Harnwegsinfektion - Mecillinam - Pivmecillinam - Zystitis

Key words

Escherichia coli - urinary tract infection - mecillinam - pivmecillinam - cystitis
 

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