Temocillin versus other intravenous beta-lactams for urinary tract infections caused by third-generation cephalosporin-resistant Enterobacterales: a multicentre retrospective matched cohort study

Background and objectives Temocillin is a carbapenem-sparing β-lactam antibiotic used to treat infections caused by third-generation cephalosporin-resistant (3GC-R) Enterobacterales, although its use is not universally recommended. The aim of this study was to compare the efficacy of temocillin with that of other parenteral beta-lactams in the treatment of febrile urinary tract infections (UTIs) caused by 3GC-R Enterobacterales. Patients and methods We conducted a multicentre, retrospective, propensity score–matched cohort study including patients treated between January 2017 and December 2021. Patients who received temocillin were matched 1:1 with patients who received carbapenems, cefepime or piperacillin/tazobactam. The primary outcome was early clinical failure, defined as a composite of persistent symptoms leading to a switch in antibiotics or death within 10 days after treatment completion. Results A total of 180 patients were included, with a high percentage of complicated UTIs (89%) but a low percentage of severe infections (21%). Early clinical failure occurred in 12% of patients overall, with no significant difference between the temocillin group (9%) and the comparator group (14%) (OR 0.58, 95% CI [0.23–1.48], P = 0.26). The rates of late clinical failure, late microbiological failure and all-cause mortality within 3 months were similar between the groups. Conclusion In this study, compared with other beta-lactams, temocillin was not associated with an increased risk of early clinical failure in the treatment of 3GC-R Enterobacterales UTIs.