Perceptions, Practices, and Treatment Approaches of Indian Physicians Towards Ceftriaxone-sulbactam-ethylenediaminetetraacetic Acid (CSE) in Managing Complicated Urinary Tract Infections (cUTI)

INTRODUCTION: Urinary tract infections (UTIs) are one of the most common infections worldwide. The absolute number of UTI cases increased by 60.40% from 252.25 million (95%UI: 223.31–279.3) in 1990 to 404.61 million (95%UI: 359.43–446.55) in 2019(1). The most common causative organism for both uncomplicated and complicated UTIs is uropathogenic Escherichia coli (UPEC) followed by Klebsiella pneumoniae, Staphylococcus saprophyticus, Enterococcus faecalis and Pseudomonas aeruginosa(2). OBJECTIVES: To evaluate perceived prevalence and practice patterns pertaining to use of Ceftriaxone Sulbactam EDTA (CSE) in management of cUTI. MATERIALS AND METHODS: An observational study conducted across India utilized a pre-structured questionnaire comprising of 10 questions to investigate the perceived prevalence and practice patterns of managing cUTI among physicians. RESULTS: A total of 134 Consulting Physicians participated, with 58.21% aged 31–40 years. Around 29.10% of physicians diagnosed 20–30 cUTI patients monthly, while 24.63% diagnosed 10–20. Majority of physicians (91.04%) identified E. coli as the main pathogen. Approximately 50% of physicians opined that 30–40% of their UTI patients had infections caused by Extended Spectrum Beta-Lactamase (ESBL)-producing E. coli, while 22.39% reported that less than 30% of their patients were affected by ESBL-producing E. coli. Catheter-associated infections were the leading cause of hospital-acquired cUTIs, according to 87.31% of physicians. The CSE was the preferred therapy for community-acquired cUTIs among 37.31% of physicians, while piperacillin-tazobactam was preferred by 26.87% physicians. For hospital-acquired cUTIs, CSE was preferred as empirical therapy by 32.84% of physicians, followed by Meropenem (31.34%). Majority of the physicians (60.45%) preferred CSE as a Carbapenem-sparing drug in treatment of ESBL UTI, 41.79% using them as targeted therapy for hospital-acquired UTIs, 23.88% for empirical treatment of community-acquired UTIs, and 12.68% as a colistin sparer drug. The most common dose of CSE for cUTI treatment was 1.5 g twice a day (BID), preferred by 65.67% of physicians. Approximately 17.16% of physicians opted for the higher dose of 3 g BID. Nausea and vomiting were the most common side effects of CSE therapy, observed by 77.61% of physicians, followed by local site reactions (12.69%). 96% of doctors gave CSE a score of 4 or 5 out of score 5 on a Likert scale, with 1 representing less safe and 5 denoting safer, for the treatment of cUTI. CONCLUSION: The CSE is a novel, well tolerated and the preferred drug of choice for the management of cUTIs among physicians in India.