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Comparative Study
. 2017 Nov;37(11):1479-1483.
doi: 10.1002/phar.2024. Epub 2017 Oct 23.

Intravenous-only or Intravenous Transitioned to Oral Antimicrobials for Enterobacteriaceae-Associated Bacteremic Urinary Tract Infection

Krista L Rieger  1   2 , John A Bosso  1   2   3 , Shawn H MacVane  1   2 , Zachary Temple  2 , Amy Wahlquist  4 , Nicole Bohm  1   2
Affiliations
Comparative Study

Intravenous-only or Intravenous Transitioned to Oral Antimicrobials for Enterobacteriaceae-Associated Bacteremic Urinary Tract Infection

Krista L Rieger et al. Pharmacotherapy. 2017 Nov.

Abstract

Objectives: To characterize antibiotic regimens utilized for bacteremic Enterobacteriaceae urinary tract infections and assess treatment failure associated with intravenous-only compared to intravenous transitioned to oral antibiotic treatment.

Design: Retrospective cohort.

Settings: Tertiary care academic medical center.

Patients: 241 adult patients hospitalized between July 1, 2010, and June 30, 2015, with positive blood and urine cultures with the same Enterobacteriaceae pathogen.

Main results: Hospital days on antibiotics as well as length of stay were less in the group treated with any oral antibiotics (intravenous/oral, median 5 [IQR 3-7] days vs intravenous-only antibiotics 6 [4-10] days, p<0.001; length of stay for intravenous/oral 4.6 [3.1-7.8] days vs intravenous-only 7.1 [4.0-17.5] days, p<0.001). No statistically significant difference was found in the composite outcome of treatment failure in patients who received intravenous-only antibiotics versus intravenous/oral antibiotics for the treatment of bacteremic urinary tract infections (intravenous-only 3.8% [95% CI: 1.0-9.4%] failure; intravenous/oral 8.2% [95% CI: 4.1-14.1%] failure; p=0.19).

Conclusions: Intravenous transitioned to oral treatment (intravenous/oral) was associated with a shorter length of stay and fewer hospital antibiotic days compared with intravenous-only therapy. Transitioning from intravenous to oral antibiotic therapy is a viable treatment option to consider for patients with bacteremic Enterobacteriaceae urinary tract infection.

Keywords: Enterobacteriaceae; antibiotic; bacteremia; fluoroquinolone; oral antibiotic; urinary tract infection.

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