Antibiotic de-escalation in bacteremic urinary tract infections: Potential opportunities and effect on outcome - Abstract

PURPOSE: The aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patients admitted with bacteremic urinary tract infection (UTI).

METHODS: A retrospective chart review of patients admitted to a community-hospital in West Texas with bacteremic UTI during the year 2008. Antibiotic de-escalation was defined as changing the intravenous empiric antibiotic regimen to a culture-directed single agent, given intravenously or orally, with a narrower spectrum than the original empiric regimen.

RESULTS: Ninety-seven patients were admitted with bacteremic UTI. Thirty-two patients were not eligible for de-escalation. Among the 65 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 31 cases (47.7%). Fluoroquinolones' resistance, bacteria other than Escherichia coli and discharge to long-term care facilities predicted failure to de-escalate antibiotics. On multivariate analysis, discharge to long-term care facility was the only risk factor that predicted failure to de-escalate antibiotics. The difference between mean hospital length of stay and mortality between the above two groups was not statistically significant.

CONCLUSION: Antibiotic de-escalation is under-recognized and sporadically practiced. In patients admitted with bacteremic UTI, empiric antibiotic regimen can be changed to a culture-directed single antibiotic without an increase in hospital length of stay or patients' mortality.

Written by:
Khasawneh FA, Karim A, Mahmood T, Ahmed S, Jaffri SF, Tate ME, Mehmood M.   Are you the author?
Section of Infectious Diseases Medicine, Department of Internal of Medicine, Texas Tech University Health Sciences Center, 1400 S. Coulter Street, Amarillo, TX, 79106, USA.  

Reference: Infection. 2014 Oct;42(5):829-34.
doi: 10.1007/s15010-014-0639-8

PubMed Abstract
PMID: 24874607 Infections Section