Defining the Optimal Duration of Therapy for Hospitalized Patients With Complicated Urinary Tract Infections and Associated Bacteremia.

Autor:	McAteer J; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Lee JH; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Cosgrove SE; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Dzintars K; Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA., Fiawoo S; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Heil EL; Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA., Kendall RE; Department of Pharmacy, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA., Louie T; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA., Malani AN; Department of Medicine, Trinity Health St. Joseph Mercy, Ann Arbor, Michigan, USA., Nori P; Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA., Percival KM; Department of Pharmaceutical Care, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA., Tamma PD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 May 03; Vol. 76 (9), pp. 1604-1612.
DOI:	10.1093/cid/ciad009
Abstrakt:	Background: Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs). Methods: We conducted an observational study of patients ≥18 years at 24 US hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity scores were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species ≤30 days of completing therapy. Results: 1099 patients met eligibility criteria and received 7 (n = 265), 10 (n = 382), or 14 (n = 452) days of therapy. There was no difference in the odds of recurrent infection for patients receiving 10 days and those receiving 14 days of therapy (aOR: .99; 95% CI: .52-1.87). Increased odds of recurrence was observed in patients receiving 7 days versus 14 days of treatment (aOR: 2.54; 95% CI: 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted (aOR: .76; 95% CI: .38-1.52). Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7-, 10-, and 14-day groups, respectively, had drug-resistant infections (P = .10). Conclusions: Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable intravenous and oral bioavailability are administered; 10 days may be needed for all other patients. Competing Interests: Potential conflicts of interest. S. E. C. reports receiving personal fees from Basilea and Theravance, outside of the submitted work, including participation on a Data Safety Monitoring Board or Advisory Board for Debiopharm. E. L. H. reports consulting fees from Wolters-Kluwer (Lexi-Comp). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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