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首页> 外文期刊>BMC Infectious Diseases >Outcomes of high-dose levofloxacin therapy remain bound to the levofloxacin minimum inhibitory concentration in complicated urinary tract infections
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Outcomes of high-dose levofloxacin therapy remain bound to the levofloxacin minimum inhibitory concentration in complicated urinary tract infections

机译：在复杂的尿路感染中，大剂量左氧氟沙星治疗的结果仍与左氧氟沙星最低抑菌浓度有关

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Background Fluoroquinolones are a guideline-recommended therapy for complicated urinary tract infections, including pyelonephritis. Elevated drug concentrations of fluoroquinolones in the urine and therapy with high-dose levofloxacin are believed to overcome resistance and effectively treat infections caused by resistant bacteria. The ASPECT-cUTI phase 3 clinical trial (ClinicalTrials.gov, NCT01345929 and NCT01345955 , both registered April 28, 2011) provided an opportunity to test this hypothesis by examining the clinical and microbiological outcomes of high-dose levofloxacin treatment by levofloxacin minimum inhibitory concentration. Methods Patients were randomly assigned 1:1 to ceftolozane/tazobactam (1.5?g intravenous every 8?h) or levofloxacin (750?mg intravenous once daily) for 7?days of therapy. The ASPECT-cUTI study provided data on 370 patients with at least one isolate of Enterobacteriaceae at baseline who were treated with levofloxacin. Outcomes were assessed at the test-of-cure (5–9 days after treatment) and late follow-up (21–42 days after treatment) visits in the microbiologically evaluable population ( N =?327). Results Test-of-cure clinical cure rates above 90% were observed at minimum inhibitory concentrations ≤4?μg/mL. Microbiological eradication rates were consistently >90% at levofloxacin minimum inhibitory concentrations ≤0.06?μg/mL. Lack of eradication of causative pathogens at the test-of-cure visit increased the likelihood of relapse by the late follow-up visit. Conclusions Results from this study do not support levofloxacin therapy for complicated urinary tract infections caused by organisms with levofloxacin minimum inhibitory concentrations ≥4?μg/mL. Trial registration ClinicalTrials.gov, NCT01345929 and NCT01345955
机译：背景技术氟喹诺酮类药物是针对包括肾盂肾炎在内的复杂尿路感染的指南推荐疗法。尿中氟喹诺酮类药物的浓度升高以及大剂量左氧氟沙星的治疗被认为可以克服耐药性并有效治疗由耐药菌引起的感染。 ASPECT-cUTI 3期临床试验（ClinicalTrials.gov，NCT01345929和NCT01345955，均于2011年4月28日注册）提供了通过检验左氧氟沙星最低抑菌浓度高剂量左氧氟沙星治疗的临床和微生物学结局来检验这一假设的机会。方法将患者随机分配1：1头孢唑烷/他唑巴坦（每8？h静脉注射1.5？g）或左氧氟沙星（每天750mg静脉注射一次），共治疗7天。 ASPECT-cUTI研究提供了在基线时接受左氧氟沙星治疗的370例至少有一种肠杆菌科细菌分离株的数据。在微生物可评估人群中，在治愈测试（治疗后5-9天）和后期随访（治疗后21-42天）中评估结果。结果在最小抑菌浓度≤4？μg/ mL时，可观察到90％以上的治愈率临床治愈率。左氧氟沙星最低抑菌浓度≤0.06？μg/ mL时，微生物根除率始终> 90％。在治愈测试访视中未能根除病原体增加了后期随访访视复发的可能性。结论这项研究结果不支持左氧氟沙星治疗由左氧氟沙星最低抑菌浓度≥4？μg/ mL的生物体引起的复杂尿路感染。试用注册ClinicalTrials.gov，NCT01345929和NCT01345955

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