ANTIBIOTIC DE-ESCALATION IN BACTEREMIC UTI & ITS IMPACT ON COST AND LENGTH OF STAY-A PROSPECTIVE OBSERVATIONAL STUDY IN A TERTIARY CARE TEACHING HOSPITAL IN SOUTH KERALA

Urinary tract infection (UTI) is one of the most common infections affecting humans and is one of the leading causes of both community-acquired and nosocomial infections. The study’s objective was to assess the rate of de-escalation and the impact of de-escalation on cost and length of stay, antibiotics utilization pattern, and adverse effects of antibiotics in bacteremic UTI. A prospective observational study was conducted on 218 UTI patients in a tertiary care hospital in Trivandrum for 6 months. The results showed that the incidence of UTI is higher in females. The most common symptom was identified as fever, followed by dysuria. Escherichia Coli was the causative organism in most of cases. Inj. Cefoperazone and Sulbactum was the most frequently prescribed antibiotic. Gastric irritation was experienced by 1.8% of patients followed by exanthema in 0.5% patients. The rate of successful de-escalation was 26.9% while 73.1% failed de-escalation. A significant association (p-value < 0.001) was found between de-escalation failure and length of stay. According to our study, the absence of de-escalation increased the cost of antibiotics prescribed. 36.1% of patients had a difference in cost per day between 0-100 rupees, followed by 30.1% in a 100-500 rupees range. A significant association (p-value < 0.001) between de-escalation failure and cost was noted. This study proves that de-escalation was associated with better patient outcomes, i.e., reduced hospital length of stay. The study shows a perspective for bettering the current de-escalation rate.