{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:59:28Z","timestamp":1771232368144,"version":"3.50.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100021697","name":"Sykehuset i Vestfold","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021697","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The role of oral beta-lactam antibiotics in treating febrile urinary tract infections (UTI) is not yet definite. Today, fluoroquinolones together with trimethoprim\u2013sulfamethoxazole (TMP\u2013MTX) are considered standard of care and often the only available evidence-based oral treatment for febrile UTI. This study clarifies the efficacy and safety of pivmecillinam (PIV) used as step-down therapy for bacteremic urinary tract infection (UTI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A single-arm, uncontrolled treatment trial was conducted in the period September 2017\u2013March 2020. Candidates for inclusion were men and women suffering from <jats:italic>E. coli<\/jats:italic> bacteremia due to UTI and were consecutively included in a Norwegian hospital. Exclusion criteria were among others: other ongoing bacterial infection, septic shock, pyonephrosis\/abscess and pregnancy. After 3\u00a0days of parenteral antibiotic, the treatment was converted to the study drug; oral PIV 400\u00a0mg QID for 1\u00a0week. Primary endpoint was a combination of three elements; afebrility, no need for retreatment and improvement in self-reported health status. Test Of Cure (TOC) was 1\u00a0week post-treatment. Secondary endpoints included among others microbiological efficacy and CRP value &lt;\u200930\u00a0mg\/L.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 476 screened subjects, 53 patients were included. Median age was 67\u00a0years, 28 (56%) were women. 50 patients were evaluated for per-protocol analysis. 44 of 50 patients (88%) (95% CI [75.7\u201395.5]) reached the primary endpoint on TOC. 14 of 48 patients (29.2%) had significant growth (&gt;\u200910<jats:sup>3<\/jats:sup>\u00a0CFU\/mL) of <jats:italic>E.coli<\/jats:italic> on TOC. CRP-level was strongly associated to treatment outcome, (OR 0.006 [95% CI 0.00\u20130.11], p\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This trial documents that PIV 400\u00a0mg QID given for 1\u00a0week following 3\u00a0days of parenteral antibiotics, is a suitable treatment option in patients suffering from bacteremic UTI due to <jats:italic>E. coli<\/jats:italic>. Randomised clinical trials studying the efficacy of PIV vs standard of care of febrile UTI are warranted.<\/jats:p>\n                <jats:p><jats:italic>Trial registration<\/jats:italic> The trial was registered at ClinicalTrials.gov under the identifier: NCT03282006 13\/09\/2017 and approved by The Regional Committees for Medical Research Ethics South East Norway (2015\/2384\/REK s\u00f8r-\u00f8st) and the Norwegian Medicines Agency (SLV; reference No 16\/06018-09; EudraCT No 2016-000984-18) before initiation<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-022-07463-7","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T09:07:04Z","timestamp":1652951224000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The efficacy of pivmecillinam in oral step-down treatment in hospitalised patients with E. coli bacteremic urinary tract infection; a single-arm, uncontrolled treatment study"],"prefix":"10.1186","volume":"22","author":[{"given":"Bj\u00f8rn \u00c5sheim","family":"Hansen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Grude","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten","family":"Lindb\u00e6k","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tore","family":"Stenstad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,5,19]]},"reference":[{"issue":"5","key":"7463_CR1","doi-asserted-by":"publisher","first-page":"e103","DOI":"10.1093\/cid\/ciq257","volume":"52","author":"K Gupta","year":"2011","unstructured":"Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. 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