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CP-130 An analysis of carbapenem prescriptions for the treatment of Complicated Urinary Tract Infections
  1. S Sadyrbaeva1,
  2. P Aznarte Padial1,
  3. C Hidalgo Tenorio2,
  4. N El-Fahimi1,
  5. F Martínez-Checa3
  1. 1Virgen de Las Nieves University Hospital, Pharmacy, Granada, Spain
  2. 2Virgen de Las Nieves University Hospital, Infectious Desease Unit, Granada, Spain
  3. 3University of Granada, Department of Microbiology, Granada, Spain

Abstract

Background Antimicrobial stewardship includes a de-escalation strategy for antimicrobial treatment. Treatment of urinary tract infections (UTI) offers a good opportunity to de-escalate antimicrobial treatment.

Purpose To evaluate the prescription of carbapenems for complicated UTIs in patients requiring hospitalisation and to measure the frequency with which de-escalation was performed.

Materials and methods A retrospective three-month study (March to June 2012) in a tertiary university hospital, of inpatients empirically treated with carbapenems for UTIs. The variables analysed were: number of patients prescribed carbapenems for UTI, requests for urinary cultures, analytical data such as leukocytes and C-reactive protein (CRP) at hospital admission, microorganisms isolated, duration of treatment, length of hospital stay and de-escalation performed. The Oncology-Haematology, Orthopaedics &Trauma, Neurosurgery and Neurology departments were excluded. De-escalation was defined as the replacement of the empirical carbapenem treatment by an antibiotic with a narrower spectrum.

Results A total of 433 prescriptions with carbapenems were recorded over these months, 52 (12%) for UTIs. The mean age was 73.5 ± 12.79 years and sex ratio: 60% Female. The most prescribed carbapenems were ertapenem (36.5%) and meropenem (30.8%). Out of a total of 27 requests for a urinary culture and sensitivity testing for carbapenem prescriptions for UTI, 17 (62.9%) were positive. The average length of treatment with carbapenems was 5 ± 2.28 days, 42% of carbapenem prescriptions were suspended due to decisions to change the antibiotic treatment (including de-escalation), 46% were discharged and 12% died. The most common pathogen isolated was Escherichia coli (70.5%), 75% of which were sensitive to amoxicillin-clavulanic acid and 96% to fosfomycin. Less common were Pseudomonas aeruginosa (8.3%) and Enterobacter cloacae (8.3%). Total treatments subject to de-escalation represented 66.6% (18/27).

Conclusions The rate of carbapenem prescriptions for UTI was low. Meropenem and ertapenem were the most prescribed. De-escalations was undertaken in a high proportion. Based on these data, more requests need to be made for microbiological tests.

No conflict of interest.

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