Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study

2020 ◽  
Author(s):  
Toshihiro Shimizu ◽  
Toru Sugihara ◽  
Jun Kamei ◽  
Saki Takeshima ◽  
Yoshitaka Kinoshita ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplantation ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Predictive Factors ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tract Infections

scholarly journals Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

2021 ◽  
Author(s):  
Noah Wald-Dickler ◽  
Todd C Lee ◽  
Soodtida Tangpraphaphorn ◽  
Susan M Butler-Wu ◽  
Nina Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Urinary Tract ◽  
Los Angeles ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Outpatient Treatment ◽  
Retrospective Cohort ◽  
Clinical Success ◽  
Public Hospitals ◽  
Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

scholarly journals 1674. Epidemiology of Urinary Tract Infections in the Renal Transplant Population in a Large Urban Midwestern Hospital: A Retrospective Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S822-S823
Author(s):  
Rebecca Nirmal Kumar ◽  
Teresa Zembower ◽  
Valentina Stosor
Keyword(s):  
Cohort Study ◽  
Urinary Tract ◽  
Renal Transplant ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multidrug Resistant ◽  
Renal Transplant Recipients ◽  
Care Hospital ◽  
Tract Infections

Abstract Background Renal Transplant Recipients (RTR) are at high risk for Urinary Tract Infections (UTIs). However, the best empiric option for treatment is not well defined, because the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae and carbapenem resistant Enterobacteriaceae (CRE). The primary purpose of this study was to describe the prevalence of multidrug resistant UTIs in a contemporary cohort of RTR at a large Midwestern tertiary care hospital. Secondary outcomes evaluated frequency of key symptoms and physical exam findings, as well as characteristics of patients who developed multidrug resistant organisms, morbidity, and mortality. Methods This was a single-center retrospective cohort study. Patients were included if they were 18 years or older and underwent their transplant between July 11, 2019 and November 26, 2018. Statistical analysis was performed using Fischer’s Exact T-test for comparison of the patients with and without ESBL UTIs. Significance was defined by a p< 0.05 Results Two hundred fifty-two patients were evaluated (median age 54.4, 38.3% female gender), 36 patients developed UTIs, and no patients had CRE organisms. ESBL UTI prevalence was 7/252 (2.8%) among the total RTR population and 7/36 (19.4%) among the population of RTR who developed UTIs. Mortality rates did not differ significantly between patients with and without ESBL UTI (0% and 6.9%, respectively, p=.489) (Table 1). Additional clinical characteristics of the patients that developed ESBL UTIs were also obtained (Table 2). Table 1: Comparison of non-ESBL UTI and ESBL UTI Table 2: Characteristics of Patients with ESBL UTI Conclusion Prevalence of ESBL UTIs among RTR are low at a tertiary Midwestern hospital. Disclosures All Authors: No reported disclosures

scholarly journals 1426. Empiric Antimicrobial Prescribing for Urinary Tract Infections in Patients Discharged from the Emergency Department

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S796-S796
Author(s):  
Megan A Rech ◽  
Brett Faine ◽  
Priyanka Vakkalanka ◽  
David A Talan
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Diagnosis ◽  
Research Network ◽  
Tract Infections ◽  
Research Grant

Abstract Background Urinary tract infections (UTIs) are commonly treated infections in the emergency department (ED), accounting for 3 million visits annually and 15% of outpatient antibiotic prescriptions. The purpose of this study was to characterize empiric and definitive antimicrobial therapy for treatment of UTIs in a nationally representative sample of ED patients. Methods This was a multicenter, retrospective cohort study utilizing the Emergency Medicine PHARMacy Research NETwork (EMPHARM-NET), a network of 15 geographically diverse EDs. Patients ≥18 years presenting to and discharged home from the ED with primary diagnosis code of cystitis, pyelonephritis, or UTI from 2018-2020 were included. We describe empiric intravenous (IV) and oral antibiotics used for the treatment of UTI in patients seen and discharged from the ED. Results Of the 3779 ED patients treated for UTI, most were discharged from the ED (n=2483, 66%). Most patients were female (76.3%) and common comorbidities were hypertension (47.8%) and diabetes (26.5%). Most patients had uncomplicated (39.4%) or complicated (40.9%) cystitis. 1134 (45.6%) had a positive urine culture, most commonly E. coli (63%) and K. pneumoniae (13%). The most common antibiotics administered in the ED were ceftriaxone (19.7%), nitrofurantoin (6.2%), cephalexin (5.8%), and sulfamethoxazole/trimethoprim (SMX/TMP, 4.8%). The most common antibiotics prescribed at discharge where cephalexin (33.9%), nitrofurantoin (20.6%), SMX/TMP (12%), ciprofloxacin (8.2%), and cefdinir (8%). The mean length of treatment was 7.1 days (standard deviation 2.5 days). Overall, 454 patients returned to the ED within 30 days. The odds of returning to the ED within 30 days was higher in those that did not have appropriate empiric antibiotics based on susceptibilities (OR 1.37, 95% confidence interval 1.06, 1.78). Conclusion This multicenter, retrospective cohort study describes ED patients discharged from the ED after UTI diagnosis. Patients presented most commonly for cystitis. Nearly half of discharged patients were culture positive. Antimicrobial selection varied; IV ceftriaxone and oral cephalexin were most commonly empirically utilized to treated patients with UTI. Inappropriate antimicrobial selection increased odds of a return ED visit within 30 days. Disclosures Megan A. Rech, PharmD, MS, BCCCP, FCCM, Spero (Research Grant or Support) Brett Faine, PharmD, Spero Therapeutics (Research Grant or Support) David A. Talan, MD, AbbVie (Consultant)GSK (Consultant)SPERO Therapeutics (Grant/Research Support)

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