Effect of a Dedicated Medical Care Unit on Management of Kidney Transplant Patients with Extended-Spectrum Beta-Lactamase Urinary Tract Infection Requiring Parenteral Ertapenem: A Single-Centre Study

Background: Extended-spectrum beta-lactamase (ESBL) producing urinary tract infections (UTIs) pose significant challenges in kidney transplant patients. This study evaluates the impact of utilizing a Dedicated Medical Care Unit (DMCU) on the management of kidney transplant patients with ESBL UTI requiring parenteral ertapenem. Methods: A single-centre retrospective study was conducted comparing hospital bed occupancy rates before and after the implementation of the DMCU. Data from October to December 2023 (pre-DMCU) were compared with data from January to June 2024 (post-DMCU). The study included adult kidney transplant patients aged 24 to 69 years with ESBL UTI. Hemodynamically unstable patients, those with acute kidney injury (AKI), and patients with constitutional symptoms were excluded from the DMCU initiative and admitted to the hospital for completion of antibiotics. Results: 120 patients received treatment for UTI in DMCU. 66% females; 14% second renal transplant recipients, and 9% were deceased kidney transplant patients. We noted monthly reduction in hospital bed occupancy ranging from 43% to 68% ( n=1104 days over 6 months) with maximum reduction of 266 days/month. Additionally, readmission rates were 18%( n=19 vs n=23) lower in patients receiving ertapenem in the DMCU compared to those completing the course as inpatients. Importantly, no treatment-associated complications were reported in the DMCU. Conclusion: The utilization of the DMCU for managing kidney transplant patients with ESBL UTI requiring parenteral ertapenem significantly reduced hospital bed occupancy and readmission rates, without any treatment-associated complications.