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

Figures & data

Table 1 Baseline Characteristics of the TMP/SMX and Ertapenem Groups

	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	Total N=103 (%)	P value
Male	9 (42.9)	26 (31.7)	35 (34)	0.44
Age (year) (median ± IQR)	63.67 ± 21.43	73.16 ± 58.07	71.11 ± 52.51	0.46
Symptom at the time of culture	21 (100)	74 (94.4)	95 (93.1)	0.34
Frequency	9 (42.9)	29 (35.4)	38 (36.9)	0.61
Urgency	8 (38.1)	15 (18.3)	23 (22.3)	0.07
Nocturia	4 (19.0)	11 (13.4)	15 (14.6)	0.50
Fever	17 (81.0)	63 (76.8)	80 (77.7)	0.78
Dysuria	15 (71.4)	42 (51.2)	57 (55.3)	0.14
CVAT	9 (42.9)	27 (32.9)	36 (35.0)	0.45
Initial shock	2 (9.5)	9 (11.0)	11 (10.7)	1.00
Residual urine	7 (33.3)	32 (39.0)	39 (37.9)	0.80
Rate of upper UTIs	90.5%	90%	90.9%	0.26
Mean duration of hospitalization (mean ± SD)	10.62 ± 14.32	27.66 ± 42.02	24.17 ± 38.42	0.07
Mean duration of total antibiotics (Intravenous plus Per oral) (Median ± IQR)	8 ± 10.50	14 ±37.00	13.41 ± 5.46	0.006
Started with selective antibiotics	0	27 (45.8)	27 (37.0)

Abbreviations: TMP/SMX, trimethoprim-sulfamethoxazole; N, number; IQR, interquartile range; CVAT, costovertebral angle tenderness; SD, standard deviation; IQR, interquartile range.

Figure 1 Flow chart of population in this study.

Table 2 Microbiological Characteristics

Pathogen	Initial Urine Culture		Initial Blood Culture		Follow-Up Urine Culture		Follow-Up Blood Culture
	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	TMP/SMX N=21 (%)	Ertapenem N=82 (%)
No growth	0	1 (1.2)	10 (47.6)	36 (43.9)	10 (47.6)	36 (43.9)	4 (19.0)	28 (34.1)
E. coli^1	18 (85.7)	66 (80.4)	4 (19.0)	14 (17.1)	4 (19.0)	14 (17.1)	0	0
K. pneumoniae^2	0	11 (13.4)	0	2 (2.44)	0	3 (5.1)	0	0
P. mirabilis^3	2 (9.5)	2 (2.4)	1 (4.7)	2 (2.44)	1 (4.7)	2 (3.4)	0	0
E. faecalis^4	0	1 (1.2)	1 (4.7)	2 (2.44)	1 (4.7)	2 (3.4)	0	0
E. faecium^5	0	0	1 (4.7)	6 (7.32)	1 (4.7)	6 (10.2)	0	0
S. maltophilia^6	0	0	0	0	0	2 (3.4)	0	0
C. albicans^7	0	0	0	0	0	3 (5.1)	0	1 (1.2)
Others	0	1 (1.2)	0	4 (4.88)	0	0	0	0
Total	20 (95.3)	82(100)	17 (81)	66 (80.5)	17 (81)	73 (84.7)	4 (19)	29 (35.3)
Not done	1 (4.7)	0	4 (19.0)	16 (19.5)	4 (19.0)	9 (15.3)	17 (81.0)	53 (64.7)

Abbreviations: ¹E. coli, Escherichia coli; ² K pneumoniae, Klebsiella pneumoniae; ³ P. mirabilis, Proteus mirabilis; ⁴E. faecalis, Enterococcus faecalis; ⁵ E. faecium, Enterococcus faecium; ⁶ S. maltophilia, Stenotrophomonas maltophilia; ⁷ C. albicans, Candida albicans.

Table 3 Clinical Outcomes of the TMP/SMX and Ertapenem Groups

	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	Total N=103 (%)	P value
Clinical cure*	19 (90.5)	69 (84.1)	88 (85.4)	0.73
Clinical improvement after 48 h of treatment	5 (23.8)	21 (25.6)	26 (25.2)	0.13
Clinical failure^#	3 (14.3)	12 (14.6)	15 (14.6)	0.99
Death within 1 month	0	2 (3.4)	2 (2.6)	0.01

Notes: Clinical cure*: clinical improvement after 72 h of adequate antibiotic treatment. Clinical failure^#: persistence of symptoms after 7 days of adequate antibiotic treatment.

Abbreviations: TMP/SMX, trimethoprim-sulfamethoxazole; N, number.

Table 4 Microbiological Outcomes for the TMP/SMX and Ertapenem Groups

	TMP/SMX N=21 (%)	Ertapenem N=82 (%)	Total N=103 (%)	P value
Microbiological cure*	19 (90.5)	48 (58.5)	67 (65.0)	0.01
Negative FUUC	10 (47.6)	35 (43.2)	45 (44.1)	0.81
Relapse**	2 (9.5)	12 (14.6)	14 (13.6)	0.73
Reinfection***	0	14 (17.1)	14 (13.6)	0.07
Recurrence****	2 (9.5)	11 (13.4)	13 (12.6)	0.78

Notes: *Microbiological cure: negative urine culture at the completion of therapy and/or absence of relapse or reinfection. **Relapse: UTI with the same organism within 30 days. *** Reinfection: UTI with a different organism within 30 days. ****Recurrence: infection with same organism within 3 months.

Abbreviations: TMP/SMX, trimethoprim-sulfamethoxazole; N, number; FUUC, follow-up urine culture.