title: Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome.
abstract: OBJECTIVE
  The aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patients admitted with bacteremic urinary tract infection (UTI).
  
  
  METHODS
  A retrospective chart review of patients admitted to a community-hospital in West Texas with bacteremic UTI during the year 2008. Antibiotic de-escalation was defined as changing the intravenous empiric antibiotic regimen to a culture-directed single agent, given intravenously or orally, with a narrower spectrum than the original empiric regimen.
  
  
  RESULTS
  Ninety-seven patients were admitted with bacteremic UTI. Thirty-two patients were not eligible for de-escalation. Among the 65 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 31 cases (47.7%). Fluoroquinolones' resistance, bacteria other than Escherichia coli and discharge to long-term care facilities predicted failure to de-escalate antibiotics. On multivariate analysis, discharge to long-term care facility was the only risk factor that predicted failure to de-escalate antibiotics. The difference between mean hospital length of stay and mortality between the above two groups was not statistically significant.
  
  
  CONCLUSIONS
  Antibiotic de-escalation is under-recognized and sporadically practiced. In patients admitted with bacteremic UTI, empiric antibiotic regimen can be changed to a culture-directed single antibiotic without an increase in hospital length of stay or patients' mortality.
authors.affiliation: Section of Infectious Diseases Medicine, Department of Internal of Medicine, Texas Tech University Health Sciences Center, 1400 S. Coulter Street, Amarillo, TX, 79106, USA, faisal.khasawneh@ttuhsc.edu.
authors.forename: F A
authors.initials: FA
authors.lastname: Khasawneh
authors.forename: A
authors.initials: A
authors.lastname: Karim
authors.forename: T
authors.initials: T
authors.lastname: Mahmood
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: S F
authors.initials: SF
authors.lastname: Jaffri
authors.forename: M E
authors.initials: ME
authors.lastname: Tate
authors.forename: M
authors.initials: M
authors.lastname: Mehmood
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects*; D002415:Cats; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents