ANTIBIOTIC TREATMENT FOR URINARY TRACT INFECTIONS IN PATIENTS WITH RENAL IMPAIRMENT AT PRINCE HUSSEIN CENTER FOR UROLOGY AND ORGAN TRANSPLANTATION

Abstract

Objectives: To evaluate antibiotic utilization, renal dosing accuracy, clinical cure, and safety profiles in patients with chronic kidney disease (CKD) presenting with urinary tract infections (UTIs). Methods: This retrospective cohort study at the Prince Hussein Center for Urology and Organ Transplantation in the Royal Medical Services (Amman, Jordan) reviewed records of adult patients with an eGFR < 60 mL/min/1.73m² treated for symptomatic UTIs between May 2022 and January 2026. Tracking parameters from 3 to 6-month follow-up included demographics, diabetes status, eGFR, uropathogens, antibiotic regimens, dosing adjustments, renal replacement therapy (RRT), adverse events, and clinical cure rates. Results: Out of 342 patients enrolled, the predominant pathogen was Escherichia coli (48.5%; 54.2% ESBL-producing). 58.5% of the cohort had diabetes mellitus. Empirical therapies mainly consisted of carbapenems (42.1%) and third-generation cephalosporins (28.4%). Notably, 34.8% of patients received unadjusted antibiotic doses relative to baseline eGFR. Inappropriate dosing was significantly associated with greater acute kidney injury (AKI) superimposition (24.3% vs. 8.5%; p < 0.005), along with increased lengths of stay in the hospital. Sub-therapeutic dosing from hemodialysis contributed to early clinical failure in 88 patients on RRT. The 6-month microbiological recurrence rate of 31.6% was associated with advanced renal deterioration. Conclusion: Prescribing unadjusted antibiotics is also common in this tertiary center. The adoption of electronic dosing alerts triggered by eGFR, customized RRT protocols, and culture-guided stewardship is critical in minimizing secondary nephrotoxicity and optimizing urological outcomes.