Takeaway
- No benefit of early appropriate empirical treatment on mortality rates or other outcomes was seen in patients with complicated urinary tract infections (cUTIs).
- Older age, corticosteroid use, being bedridden, metastasis, catheter-associated UTI (CaUTI) infection, septic shock, and ICU admission were risk factors for treatment failure.
- Supportive treatment should be considered until the cause of sepsis is clear and the causative pathogen is identified.
Why this matters
- Previous studies have reported high treatment failure rates in patients with cUTIs and pyelonephritis due to hospitalisation, presence of resistant organism, diabetes mellitus, and history of kidney stones.
Study design
- Multinational, multicentre, retrospective cohort study of 981 patients (no treatment failure, n=720; treatment failure, n=261) with diagnosis of cUTI between 2013 and 2014.
- Patients were assessed for treatment failure and all-cause mortality.
- Funding: Innovative Medicines Initiative Joint Undertaking from the European Union Seventh Framework Programme.
Key results
- 30-day all-cause mortality rate was 8.7% and treatment failure rate was 26.6%.
- Risk factors for treatment failures were ICU admission (OR, 5.07; 95% CI, 3.18-8.07), septic shock (OR, 1.92; 95% CI, 0.93-3.98), corticosteroid treatment (OR, 1.92; 95% CI, 1.12-3.54), bedridden (OR, 2.11; 95% C, 1.4-3.18), older age (OR, 1.02; 95% CI, 1.007-1.03), metastatic cancer (OR, 2.89; 95% CI, 1.46-5.73) and CaUTI (OR, 1.48; 95% CI, 1.04-2.11).
- Empirical antibiotic therapy was much more commonly used in patients with pyelonephritis vs other CaUTI (P<.005); however, it offered no significant advantage in treatment failure rates and 30-day mortality rates.
Limitations
- Retrospective study design.
References
References
