Outcomes of high-dose oral beta-lactam definitive therapy compared to fluoroquinolone or trimethoprim-sulfamethoxazole oral therapy for bacteremia secondary to a urinary tract infection

Abstract Objective: Compare outcomes of patients receiving high-dose oral beta-lactam versus standard therapy for Enterobacterales bacteremia from a urinary tract infection (UTI). Design: Retrospective, multicenter, observational cohort. Setting: Three Michigan community teaching hospitals. Patients: Adult admitted between February 1, 2020, and October 2022, with gram-negative source were evaluated. Patients active empiric intravenous (IV) antibiotics transitioned to appropriately dosed cephalexin, amoxicillin, fluoroquinolone (FQ), or trimethoprim/sulfamethoxazole (TMP/SMX) included. less than 72 hours therapy, diagnosed renal abscess, lobar nephronia, expired during admission excluded. Methods: Standard was defined as FQ TMP/SMX. The primary outcome compared the composite recurrent mortality within 30 days groups. Secondary UTI, emergency department hospital readmission, Clostridioides difficile days. Results: 194 included (beta-lactam, n = 75 vs =119). in both groups treated median 11 days, 4 IV 7 therapy. There no difference (beta-lactam 1.3% 1.7%, OR 1.27 [95% CI 0.11–14.2]). No experienced C. either group ( p 1.0). Infectious disease consultation independently associated prescribing (OR 4.4 2.24–8.26]). Conclusion: High-dose beta-lactams safe effective TMP/SMX treatment source. Most received 8–10