Temocillin for the Treatment of Urinary Tract Infections: First Italian Data from a Multicentre Real-World Experience

Background: Temocillin is a narrow-spectrum β-lactam with activity against extended-spectrum β-lactamase (ESBL)- and AmpC-producing Enterobacterales and represents a potential carbapenem-sparing option, especially for urinary tract infections (UTIs). This multicentre study evaluated the real-world use, clinical outcomes, and tolerability of temocillin in Italian clinical practice. Methods: We retrospectively included adults treated with temocillin for UTIs, with or without concomitant bloodstream infection, for at least 5 days at three Italian hospitals between November 2024 and May 2026. Data were collected from electronic medical records. Results: The study included 30 patients. Median age was 51 years (IQR 39-74); 50% presented with sepsis and 40% had UTI-associated bacteraemia. Pyelonephritis was the most common presentation (53.3%). At least one positive culture was obtained in 76.7% of patients, yielding 28 isolates. Of these, 27 were Enterobacterales, and 21/27 (77.8%) were ESBL producers. E. coli accounted for 64.3% of all isolates. Temocillin was administered at 6 g/day in 80% of patients and by continuous infusion in 76.7%. Outpatient parenteral antimicrobial therapy (OPAT) using elastomeric pumps was used in 16.7% of patients. Clinical success at the end of the overall antimicrobial treatment course was achieved in 28/30 patients (93.3%; 95% CI 77.9-99.2%). No recurrence occurred within 30 days, and no treatment-related adverse events directly attributable to temocillin were recorded. Two patients developed Clostridioides difficile infection within 60 days after treatment completion, with no established causal relationship with temocillin. Conclusions: This first Italian multicentre real-world experience reports favourable clinical outcomes with temocillin in UTIs, including in selected patients with sepsis or UTI-associated bloodstream infection, and describes the use of continuous infusion and OPAT in appropriately selected patients.