Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs
Hye Jin Shi, Jae Hee Wee, Joong Sik Eom Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, KoreaCorrespondence: Joong Sik EomDivision of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-09-01
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| Series: | Infection and Drug Resistance |
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| Online Access: | https://www.dovepress.com/challenges-to-early-discharge-of-patients-with-upper-urinary-tract-inf-peer-reviewed-fulltext-article-IDR |
| _version_ | 1818909445175902208 |
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| author | Shi HJ Wee JH Eom JS |
| author_facet | Shi HJ Wee JH Eom JS |
| author_sort | Shi HJ |
| collection | DOAJ |
| description | Hye Jin Shi, Jae Hee Wee, Joong Sik Eom Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, KoreaCorrespondence: Joong Sik EomDivision of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, (21565) 774 Beon-gil 21, Namdongdae-ro, Namdong-gu, Incheon, KoreaTel +82-32-460-2630Fax +82-32-460-2631Email helppl@gachon.ac.krBackground: Urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing pathogens have increased and are treated with carbapenem in general. Carbapenem use is associated with prolonged hospitalization or daily outpatient visit. The aim of this study was to investigate patients with UTIs by ESBL-producing pathogens for early discharge using an old oral antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), which is susceptible to ESBL-producing pathogens.Methods: Data on UTIs caused by ESBL-producing pathogens from a single tertiary hospital were collected retrospectively. Patients who had been treated with intravenous carbapenems or oral TMP/SMX were included. Patients’ clinical and microbiological outcomes were compared between oral TMP/SMX and ertapenem treatment groups.Results: A total of 103 patients were included, 21 of whom had been treated with TMP/SMX, whereas 82 with ertapenem. Clinical outcomes between the two groups were not significantly different (TMP/SMX: 90.5%; ertapenem: 84.1%, p = 0.73). The microbiological cure rate was higher in the TMP/SMX group than in the ertapenem group (90.5% vs 58.5%, respectively, p = 0.01). The mean duration of hospitalization was significantly shorter in the TMP/SMX group than in the ertapenem group (8.00 ± 10.50 days vs 14.00 ± 37.00 days, p = 0.07). The mean duration of antibiotic treatment was longer in the ertapenem group than in the TMP/SMX group (16.45 ± 4.77 vs 12.76 ± 5.37 days, p = 0.006).Conclusion: For susceptible pathogens, TMP/SMX may enable early discharge as an effective oral antibiotic treatment option for UTIs caused by ESBL-positive pathogens. Additionally, use of oral antibiotics can shorten hospital stays and reduce medical costs.Keywords: oral antibiotics, ESBL, UTI, TMP/SMX, outpatient treatment |
| first_indexed | 2024-12-19T22:27:01Z |
| format | Article |
| id | doaj.art-2b488aa3dcba49009d24a27eae57b8fa |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-12-19T22:27:01Z |
| publishDate | 2021-09-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-2b488aa3dcba49009d24a27eae57b8fa2022-12-21T20:03:29ZengDove Medical PressInfection and Drug Resistance1178-69732021-09-01Volume 143589359768458Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower CostsShi HJWee JHEom JSHye Jin Shi, Jae Hee Wee, Joong Sik Eom Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, KoreaCorrespondence: Joong Sik EomDivision of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, (21565) 774 Beon-gil 21, Namdongdae-ro, Namdong-gu, Incheon, KoreaTel +82-32-460-2630Fax +82-32-460-2631Email helppl@gachon.ac.krBackground: Urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing pathogens have increased and are treated with carbapenem in general. Carbapenem use is associated with prolonged hospitalization or daily outpatient visit. The aim of this study was to investigate patients with UTIs by ESBL-producing pathogens for early discharge using an old oral antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), which is susceptible to ESBL-producing pathogens.Methods: Data on UTIs caused by ESBL-producing pathogens from a single tertiary hospital were collected retrospectively. Patients who had been treated with intravenous carbapenems or oral TMP/SMX were included. Patients’ clinical and microbiological outcomes were compared between oral TMP/SMX and ertapenem treatment groups.Results: A total of 103 patients were included, 21 of whom had been treated with TMP/SMX, whereas 82 with ertapenem. Clinical outcomes between the two groups were not significantly different (TMP/SMX: 90.5%; ertapenem: 84.1%, p = 0.73). The microbiological cure rate was higher in the TMP/SMX group than in the ertapenem group (90.5% vs 58.5%, respectively, p = 0.01). The mean duration of hospitalization was significantly shorter in the TMP/SMX group than in the ertapenem group (8.00 ± 10.50 days vs 14.00 ± 37.00 days, p = 0.07). The mean duration of antibiotic treatment was longer in the ertapenem group than in the TMP/SMX group (16.45 ± 4.77 vs 12.76 ± 5.37 days, p = 0.006).Conclusion: For susceptible pathogens, TMP/SMX may enable early discharge as an effective oral antibiotic treatment option for UTIs caused by ESBL-positive pathogens. Additionally, use of oral antibiotics can shorten hospital stays and reduce medical costs.Keywords: oral antibiotics, ESBL, UTI, TMP/SMX, outpatient treatmenthttps://www.dovepress.com/challenges-to-early-discharge-of-patients-with-upper-urinary-tract-inf-peer-reviewed-fulltext-article-IDRoral antibioticsesblutitmp/smxoutpatient treatment |
| spellingShingle | Shi HJ Wee JH Eom JS Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs Infection and Drug Resistance oral antibiotics esbl uti tmp/smx outpatient treatment |
| title | Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs |
| title_full | Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs |
| title_fullStr | Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs |
| title_full_unstemmed | Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs |
| title_short | Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs |
| title_sort | challenges to early discharge of patients with upper urinary tract infections by esbl producers tmp smx as a step down therapy for shorter hospitalization and lower costs |
| topic | oral antibiotics esbl uti tmp/smx outpatient treatment |
| url | https://www.dovepress.com/challenges-to-early-discharge-of-patients-with-upper-urinary-tract-inf-peer-reviewed-fulltext-article-IDR |
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