Intravenous-only or Intravenous Transitioned to Oral Antimicrobials for Enterobacteriaceae-Associated Bacteremic Urinary Tract Infection.
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.
['Rieger|Krista L|KL|http://orcid.org/0000-0002-8665-9054', 'Bosso|John A|JA|', 'MacVane|Shawn H|SH|http://orcid.org/0000-0002-8019-2270', 'Temple|Zachary|Z|', 'Wahlquist|Amy|A|', 'Bohm|Nicole|N|']
D061605:Administration, Intravenous D000284:Administration, Oral D000368:Aged D000900:Anti-Bacterial Agents D016470:Bacteremia D015331:Cohort Studies D004755:Enterobacteriaceae D004756:Enterobacteriaceae Infections D005260:Female D006760:Hospitalization D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D012189:Retrospective Studies D017211:Treatment Failure D016896:Treatment Outcome D014552:Urinary Tract Infections
urinary tract infection antibiotic Enterobacteriaceae oral antibiotic bacteremia fluoroquinolone