Abstract
Objective
Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTI).
Methods
We conducted an observational study of patients ≥18 years at 24 United States 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 sco res were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species within 30 days of completing therapy.
Results
1,099 patients met eligibility criteria and received 7, 10, or 14 days of therapy. There was no difference in the odds of recurrent infection for 382 (46%) patients receiving 10 days and 452 (54%) patients receiving 14 days of therapy (aOR 0.99, 95% CI, 0.52-1.87). An increased odds of recurrence was observed in 265 (37%) patients receiving 7 days versus 452 (63%) patients receiving 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 0.76, 95% CI, 0.38-1.52. Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7, 10, and 14-day groups, respecti vely, had drug-resistant infections (p=0.10).
Conclusion
Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable IV and oral bioavailability are administered; 10 days may be needed for all other patients.
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