Int J Antimicrob Agents. 2022 Jan 26:106541. doi: 10.1016/j.ijantimicag.2022.106541. Online ahead of print.
The Infectious Diseases Society of America recommends numerous antibiotics for the treatment of extended-spectrum beta-lactamase (ESBL)-producing urinary tract infections (UTIs). The purpose of this study is to evaluate clinical outcomes of oral step-down antibiotics compared to continued IV therapy in UTIs without bacteremia. This multicenter retrospective cohort study was conducted in hospitalized patients with ESBL-producing UTIs between July 2016 and March 2020. The primary outcome was all-cause clinical failure: 30-day readmission, hospital mortality, or a change in oral antibiotics during hospitalization. Secondary outcomes include: primary outcome components, readmission due to a recurrent UTI, change in antibiotic during hospitalization, hospital length of stay, antibiotic costs, and adverse events. The study included 153 patients. The primary outcome occurred in 28% of both groups (27/95 vs. 16/58, p=0.91). The primary outcome components were similar: readmission (93% vs. 94%, p=0.95), recurrent UTIs (33% vs. 25%, p=0.73), hospital mortality (7% vs. 6%, p=1.0), and change in antibiotics (0% vs. 2%, p=0.38). Mean length of stay and direct antibiotic cost were 9.7±6.2 vs. 5.2±2.8 days (p<0.01) and $296±190 vs. $183±84 (p<0.01), respectively. Adverse events were similar except diarrhea (15% vs. 2%, p=0.01). There was no difference in clinical failure, readmission rate, mortality rate, or antibiotic change between groups. The switch group was associated with reduced hospital length of stay and inpatient antibiotic cost.