Abstract
OBJECTIVE: To evaluate the prevalence and outcomes of carbapenem de-escalation among hospitalized urinary tract infection (UTI) patients at Jordan University Hospital from January 2022 to March 2024. METHODS: This retrospective study included adult patients who received carbapenems as empirical therapy and underwent urine culture testing. Patients who were discharged before culture results (n = 31) were excluded. The primary outcome was to assess the rate of effective de-escalation, which is the transition to a narrower-spectrum antibiotic without therapeutic failure. Secondary outcomes included the effect on successful de-escalation on patients' hospital length of stay, and the relationship between urine culture results and the success of de-escalation. When determining whether to de-escalate, factors such as clinical stability, and urine culture results and susceptibility were considered. Chi-square test assessed associations between culture results and de-escalation success. RESULTS: A total of 205 patients who received carbapenems as empirical therapy and underwent urine culture testing were included in the study. Out of these, 116 individuals (56.6%) had negative culture results, indicating no infection, while 89 individuals (43.4%) tested positive, confirming the presence of an infection. Among these patients, 95.6% (196 out of 205) required de-escalation of their treatment, whereas 4.4% did not. The prevalence of successful de-escalation was 40.3% (79 out of 196). The analysis revealed that successful de-escalation is much more likely in cases with urine cultures showing growth (86.8%) compared to those with no growth (17.2%) (p = 0.001). The study also indicated no significant differences in the length of hospital stay between the successfully de-escalated group and those who failed or were incorrectly de-escalated (P > 0.05). CONCLUSIONS: The study underscores the challenges of implementing effective antibiotic stewardship in UTI management, particularly regarding carbapenem de-escalation. Enhanced protocols and clinician education are essential to optimize de-escalation practices, especially in cases with negative microbiological results. Further research is needed to refine these strategies and address the growing issue of antibiotic resistance in UTIs.