The impact of initial antibiotic treatment failure: Real-world insights in patients with complicated urinary tract infection

J Infect. 2018 Feb;76(2):121-131. doi: 10.1016/j.jinf.2017.11.001. Epub 2017 Nov 8.


Objectives: RECOMMEND (NCT02364284; D4280R00005) assessed treatment patterns and outcomes associated with initial antibiotic therapy (IAT; antibiotics received <48 h post-initiation of antibiotic therapy) in healthcare-associated infections across five countries.

Methods: Data from medical records of hospitalized patients aged ≥18 years with healthcare-associated complicated urinary tract infections (cUTI) are presented. Univariate and multivariate logistic regression analyses identified potential risk factors associated with IAT failure.

Results: Mean (SD) age was 68.7 (17.4) years (n = 408). In patients with microbiological documentation (357/408), Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common (47.1%, 21.6% and 11.8%, respectively); 46.1% of patients had a multidrug resistant (MDR) pathogen isolated. Most patients received monotherapy IAT (72.5%). Mean IAT duration was 7.8 days. IAT failure, in-hospital mortality, and mortality 30-day post-discharge were 54.4%, 35.0% and 37.3%, respectively. IAT failure was associated with age, Deyo-Charlson comorbidity score, country, MDR status and ICU admission in the univariate analysis; and country and age in the multivariate analysis.

Conclusions: This study provides real-world insights into the high rates of IAT failure and morbidity observed in patients with cUTI. Further study is imperative to understand the epidemiology of cUTI, support appropriate IAT selection and management, and reduce the burden of this disease.

Keywords: Complicated urinary tract infection; Healthcare-associated; Initial antibiotic therapy; Real-world evidence.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Cross Infection / drug therapy
  • Drug Resistance, Multiple, Bacterial
  • Escherichia coli / drug effects
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Klebsiella pneumoniae / drug effects
  • Male
  • Middle Aged
  • Morbidity
  • Pseudomonas aeruginosa / drug effects
  • Retrospective Studies
  • Treatment Failure*
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / microbiology


  • Anti-Bacterial Agents

Associated data