ROLE OF DE-ESCALATION OF ANTIBIOTIC THERAPY IN PATIENTS WITH URINARY TRACT INFECTIONS

Bellam S Subhasree¹, Noyal Mariya Joseph², Anandhalakshmi Subramanian^3,*, Ahmed Musa Al-Hakami³, Reba Kanungo¹

Kanungo¹

¹Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014 - ²Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Pondicherry 605006 - ³Department of Microbiology and Parasitology College of Medicine King Khalid University Abha, Saudi Arabia 62521

Introduction: The impact of de-escalation has not been studied in hospitalized patients with urinary tract infections (UTI). With the increasing use of empirical broad-spectrum antibiotics in patients with UTIs, there is a need to study the use of de-escalation in these patients. The aim of this study is to assess the frequency of de-escalation and outcomes in patients with urinary tract infections and to estimate the frequency of legitimate causes for the omission of de-escalation. 

Methods: A descriptive study was conducted over a period of six months at a tertiary care teaching hospital in South India. Patients with urinary tract infections who were treated with empiric broad-spectrum antibiotics were included in this study. A urine culture was performed and the patients were followed up for any change in antibiotic therapy. The final outcomes of all the patients were noted.

Results: Of the 75 patients with UTIs who were treated empirically, de-escalation was done in only 31 (42%) patients. Legitimate causes for omission of de-escalation were observed in only 21.3% of patients with UTIs. In 37.3% of the patients with UTIs, de-escalation was omitted without any valid justifications. De-escalation was associated with a reduction in the mean duration of treatment and rate of re-infection. The mortality rate remained unaffected by de-escalation.

Conclusion: De-escalation is a feasible and safe strategy that is associated with a reduction in the duration of treatment, and hospital stays with no excess mortality and therefore should be routinely practiced.