Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID-19 pandemic

Background Physicians hospitalize the patients with complicated urinary tract infections (cUTIs) when they need intravenous antibiotics and outpatient parenteral antimicrobial therapy (OPAT) is unavailable. Daily inpatient antimicrobial therapy is an alternative to hospitalization, which is similar to OPAT; patients go home after they are administered antibiotics in a separate room in the hospital setting. Objectives We assessed our previous daily inpatient practice to revitalize the model in the COVID-19 era. Materials and Methods We retrospectively evaluated the clinical and microbiological responses and the cost effectiveness of the patients with cUTIs who received daily inpatient ertapenem therapy. Results Our study population was 136 patients in 156 episodes. It was a difficult-to-treat group with older age (mean 63.0 +/- 14.8 years) and a high burden of underlying conditions (86.5%). The most common causative organisms were Escherichia coli (74.4%) and Klebsiella pneumoniae (19.2%); 89.7% of the isolates were producing extended-spectrum beta lactamase (ESBL). The microbiologic and clinical success rates were 82.1% and 95.5%, respectively. The patients required hospitalization in 16 episodes (10.2%) because of clinical failures (3.8%), superinfections (2%), planned invasive interventions (3.2%), and side effects (1.2%). Our university hospital saved 1608 bed-days and 2596 euro (9702 TL) bed costs. Conclusions In the COVID-19 pandemic period, this seems to be an effective, safe, and cost-effective way to decrease hospitalizations for cUTIs in settings where OPAT is unavailable.