A Systematic Review and Meta-analysis of Efficacy of Carbapenems versus Other Best Available Antibiotics in the Management of Patients with Urinary Tract Infections

Introduction: Carbapenems are found in high concentrations in urine and are mainly eliminated by the kidney. Hence, they are the preferred treatment for pyelonephritis and complicated urinary tract infections (cUTIs) caused by extended-spectrum β-lactamase (ESBL) producing bacteria. The recent emergence of bacterial resistance to carbapenems has resulted in the need to search for alternative treatments for complicated UTIs. This review aims to evaluate the efficacy of Carbapenems versus Piperacillin/tacobactam (or the best available antibiotic therapy) in the management of pyelonephritis in patients with upper UTIs.

Methods: A systematic review was carried out to compile all relevant studies on the use of Carbapenems versus Piperacillin/tacobactam in the treatment of upper urinary tract infections, namely pyelonephritis. A meta-analysis was carried out of the selected studies, including clinical trials composed of adult patients aged between 18 and 80 years old diagnosed with pyelonephritis. Primary screening of eligible studies was followed by the removal of duplicates and exclusion of non-eligible and unavailable full-text trials.

Results: This review included four studies on the treatment of complicated pyelonephritis. The number of patients included per study varied and ranged from 62 to 421 cases. Different types and regimes of carbapenems were used, including intravenous Meropenem-Vaborbactam, Meropenem, Biapenem, Doripenem, or Ertapenem. The included studies compared carbapenems to Piperacillin/tazobactam or other best available therapies, such as third-generation cephalosporin. For microbial failure, the overall risk ratio was 0.95 with a confidence interval range between 0.62 and 1.45, and for clinical failure, the overall risk ratio was 0.86 with a confidence interval range between 0.51 and 1.45.

Conclusions: According to the meta-analysis, the included studies showed that Carbapenems are not inferior to the comparators for the management of complicated urinary tract infections.