• F A Khasawneh, A Karim, T Mahmood, S Ahmed, S F Jaffri, M E Tate, and M Mehmood.
• 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.
• Infection. 2014 Oct 1;42(5):829-34.

PurposeThe aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patients admitted with bacteremic urinary tract infection (UTI).MethodsA 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.ResultsNinety-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.ConclusionAntibiotic 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.

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