This was a prospective, observational single-centre cohort that included 262 consecutive episodes of complicated urinary tract infection (cUTI) managed in a tertiary Hospital-at-Home (HaH) unit between March 2023 and October 2025. Baseline variables, urological history, microbiological results, treatment regimens and outcomes were recorded prospectively as part of routine HaH care. The cohort was elderly and multimorbid, with a median age of 79.7 years (Q1–Q3 66.1–87.2) and 76.0% of patients having multimorbidity.
The study aimed to describe the clinical, urological and microbiological profile of cUTI episodes managed in HaH, to report antimicrobial treatments used, to present outcomes during HaH and within 30 days, and to explore factors associated with a composite 30-day endpoint of unplanned readmission or death.
Microbiological testing identified Escherichia coli as the most frequent pathogen, accounting for 45.4% of isolates. A high proportion of E. coli isolates (41.2%) were extended-spectrum beta-lactamase (ESBL) producing. The overall proportion of isolates carrying resistance mechanisms was 30.2% (95% CI 24.9–36.0%). These findings document a substantial burden of antimicrobial resistance within a cUTI population managed in HaH.
Intravenous antimicrobial therapy in this HaH cohort most commonly involved ertapenem (42.8% of episodes) and ceftriaxone (41.2%). These two agents were the predominant choices for parenteral treatment, reflecting local prescribing patterns in the context of the identified resistance profile.
Clinical cure during the HaH episode was achieved in 92.0% of episodes (95% CI 88.1–94.7%). Unplanned transfer from HaH to conventional inpatient care occurred in 5.3% of episodes (95% CI 3.2–8.8%). There were no deaths recorded during the HaH episode itself.
When outcomes were assessed through 30 days after the HaH episode, 11.5% of episodes (95% CI 8.1–15.9%) were followed by hospital readmission and 4.2% (95% CI 2.4–7.4%) were followed by death. The composite 30-day endpoint of unplanned readmission or death occurred in 13.4% of episodes (95% CI 9.8–18.0%).
These outcome rates indicate that, despite a high prevalence of resistant organisms, HaH/OPAT management achieved high immediate clinical cure with a modest proportion of subsequent readmissions and deaths within 30 days.
An exploratory, hypothesis-generating multivariable logistic regression was performed to examine associations with the 30-day composite of unplanned readmission or death. The analysis was limited by the relatively small number of events, resulting in wide confidence intervals for effect estimates.
Two factors emerged as potential markers associated with the composite endpoint: older age (reported odds ratio 1.05 per year, 95% CI 1.01–1.10) and prior urological manipulation (odds ratio 2.98, 95% CI 1.12–7.98). The authors emphasize that these findings are exploratory and should be interpreted cautiously; they require confirmation in larger, adequately powered cohorts before being used for risk stratification at HaH admission.
In this uncontrolled, single-centre descriptive cohort, HaH/OPAT management of cUTI was associated with a high clinical cure rate and a low rate of unplanned transfer to conventional inpatient care. These favorable immediate outcomes were observed despite a substantial prevalence of ESBL-producing E. coli and other resistance-mechanism-positive isolates.
Limitations inherent to the study design include the single-centre setting, lack of a comparator group (for example, conventional inpatient care), and a small number of adverse events limiting the power of multivariable analyses. The authors note that the exploratory associations identified—older age and prior urological manipulation—are hypothesis-generating and require validation.
Implications for practice include the potential feasibility and effectiveness of HaH/OPAT for managing cUTI in older, comorbid populations, even when resistance mechanisms are common. However, adoption of HaH pathways should be accompanied by careful patient selection, microbiological oversight, and prospective evaluation of outcomes, particularly in patients with prior urological interventions or advanced age.
The study received ethics approval from the Research Ethics Committee of Hospital Universitario de La Princesa (protocol no. 5605, CEIm 12/24, 20 June 2024). Given the observational design and use of anonymised routinely collected HaH data, the committee waived the requirement for individual informed consent. The authors declared no competing interests.
Overall, this cohort documents real-world microbiological challenges and generally favorable short-term outcomes for cUTI managed in a HaH setting, and underscores the need for larger studies to validate risk markers for 30-day adverse events.