Carbapenem De-escalation in urinary tract infections: prevalence and outcomes among hospitalized patients

Abstract

Abstract Objective To evaluate the prevalence and outcomes of carbapenem de-escalation among hospitalized urinary tract infection (UTI) patients at Jordan University Hospital from January 2022 to March 2024. Methods This retrospective study included adult patients who received carbapenems as empirical therapy and underwent urine culture testing. Patients who were discharged before culture results (n = 31) were excluded. The primary outcome was to assess the rate of effective de-escalation, which is the transition to a narrower-spectrum antibiotic without therapeutic failure. Secondary outcomes included the effect on successful de-escalation on patients’ hospital length of stay, and the relationship between urine culture results and the success of de-escalation. When determining whether to de-escalate, factors such as clinical stability, and urine culture results and susceptibility were considered. Chi-square test assessed associations between culture results and de-escalation success. Results A total of 205 patients who received carbapenems as empirical therapy and underwent urine culture testing were included in the study. Out of these, 116 individuals (56.6%) had negative culture results, indicating no infection, while 89 individuals (43.4%) tested positive, confirming the presence of an infection. Among these patients, 95.6% (196 out of 205) required de-escalation of their treatment, whereas 4.4% did not. The prevalence of successful de-escalation was 40.3% (79 out of 196). The analysis revealed that successful de-escalation is much more likely in cases with urine cultures showing growth (86.8%) compared to those with no growth (17.2%) (p = 0.001). The study also indicated no significant differences in the length of hospital stay between the successfully de-escalated group and those who failed or were incorrectly de-escalated (P > 0.05). Conclusions The study underscores the challenges of implementing effective antibiotic stewardship in UTI management, particularly regarding carbapenem de-escalation. Enhanced protocols and clinician education are essential to optimize de-escalation practices, especially in cases with negative microbiological results. Further research is needed to refine these strategies and address the growing issue of antibiotic resistance in UTIs.

Keywords

• Antibiotic resistance
• Empiric antibiotic
• Carbapenem
• Urine culture
• Susceptibility test
• Jordan