Escherichia coli and MSSA urinary tract infections: Carbapenem de-escalation challenges and outcomes
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Rana K Abu-Farha 1 * , Lobna Gharaibeh 2 , Rama Alkhawaldeh 3 , Khawla Abu Hammour 4 , Ammena Y Binsaleh 5 , Sireen A Shilbayeh 5 , Fahmi Y Al-Ashwal 6 7
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1 Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JORDAN2 Department of Pharmacy, College of Pharmacy, Amman Arab University, Mubis, 11953, JORDAN3 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MALAYSIA4 Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, JORDAN5 Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, SAUDI ARABIA6 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana’a, YEMEN7 College of Pharmacy, Al-Ayen Iraqi University, AUIQ, An Nasiriyah, IRAQ* Corresponding Author

Abstract

This retrospective study evaluated carbapenem de-escalation in urinary tract infection patients with Escherichia coli (E. coli) or Methicillin-sensitive Staphylococcus aureus (MSSA) at Jordan University Hospital from January 2019 to July 2021. Among 398 patients who received empiric carbapenem therapy, 94 (23.6%) had positive urine cultures. Specifically, 67 patients had E. coli, 11 had MSSA, and 16 had both pathogens, with most (83%) having infections with a single organism. Only 9.6% of patients underwent successful de-escalation to a narrower-spectrum antibiotic within 48 hours of culture results, while 2.1% were incorrectly de-escalated. Interestingly, those who were successfully de-escalated had a longer median hospital stay (27 days, inter-quartile range [IQR] = 24) compared to those who failed or were incorrectly de-escalated (median = 9 days, IQR = 10) (p = 0.004). The low rate of de-escalation may reflect physicians’ reluctance to switch from broad-spectrum to narrow-spectrum antibiotics. Additionally, the longer hospital stays associated with successful de-escalation suggest the presence of underlying clinical factors influencing physicians’ behavior.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, Volume 22, Issue 6, December 2025, Article No: em698

https://doi.org/10.29333/ejgm/17392

Publication date: 09 Nov 2025

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