---
title: "Complicated UTIs Managed in Hospital-at-Home: Clinical, Microbiological Profile and Outcomes"
id: "pubmed-42663904"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42663904"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42663904/"
doi: "10.1007/s10096-026-05648-5"
published_at: "2026-08-28T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Complicated UTIs Managed in Hospital-at-Home: Clinical, Microbiological Profile and Outcomes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42663904
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42663904/)
- **DOI:** [10.1007/s10096-026-05648-5](https://doi.org/10.1007%2Fs10096-026-05648-5)
- **Published At:** 2026-08-28T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Prospective single-centre cohort of 262 consecutive episodes of **complicated urinary tract infection** (cUTI) managed in a tertiary **Hospital-at-Home (HaH)** unit from March 2023 to October 2025. - Median patient age was 79.7 years (IQR 66.1–87.2) and 76.0% had multimorbidity, indicating a predominantly older, comorbid population. - Escherichia coli was the most common isolate (45.4% of isolates); 41.2% of E. coli isolates produced **ESBL**. Overall rate of resistance-mechanism-positive isolates was 30.2% (95% CI 24.9–36.0%). - The two most-used intravenous antimicrobials were **ertapenem** (42.8%) and **ceftriaxone** (41.2%). - Clinical cure was achieved in 92.0% of episodes (95% CI 88.1–94.7%). Unplanned transfer to conventional inpatient care occurred in 5.3% (95% CI 3.2–8.8%) and there were no deaths during the HaH episode. - Within 30 days, 11.5% of episodes led to hospital readmission (95% CI 8.1–15.9%) and 4.2% to death (95% CI 2.4–7.4%), yielding a composite 30-day endpoint (unplanned readmission or death) of 13.4% (95% CI 9.8–18.0%). - Exploratory multivariable analysis—limited by few events—identified older age (OR 1.05 per year, 95% CI 1.01–1.10) and prior urological manipulation (OR 2.98, 95% CI 1.12–7.98) as potential factors associated with the 30-day composite endpoint. - Authors conclude HaH/OPAT management of cUTI was associated with high clinical cure and low in-programme transfers despite a substantial burden of antimicrobial resistance; they recommend larger cohorts to validate risk markers. - Ethics approval and waiver of individual consent were granted by the Hospital Universitario de La Princesa Research Ethics Committee (protocol no. 5605, CEIm 12/24, 20 June 2024).
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Online ahead of print. # Clinical and microbiological characteristics and outcomes of complicated urinary tract infections managed in a hospital-at-home programme: a prospective observational cohort study [Lira Pelari-Mici](https://pubmed.ncbi.nlm.nih.gov/?term=Pelari-Mici+L&cauthor_id=42663904)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-1 "Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain."), [Elena Arranz Canales](https://pubmed.ncbi.nlm.nih.gov/?term=Arranz+Canales+E&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Alexia Constanza Espiño Álvarez](https://pubmed.ncbi.nlm.nih.gov/?term=Espi%C3%B1o+%C3%81lvarez+AC&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Eva María Fernández Bermejo](https://pubmed.ncbi.nlm.nih.gov/?term=Fern%C3%A1ndez+Bermejo+EM&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Ángela Sánchez Juez](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%A1nchez+Juez+%C3%81&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Victoria Gutiérrez Gómez-Lus](https://pubmed.ncbi.nlm.nih.gov/?term=Guti%C3%A9rrez+G%C3%B3mez-Lus+V&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Fernando Ruiz Berraco](https://pubmed.ncbi.nlm.nih.gov/?term=Ruiz+Berraco+F&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Saida Alonso Marrero](https://pubmed.ncbi.nlm.nih.gov/?term=Alonso+Marrero+S&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Jaime Bustos Carpio](https://pubmed.ncbi.nlm.nih.gov/?term=Bustos+Carpio+J&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [José Curbelo](https://pubmed.ncbi.nlm.nih.gov/?term=Curbelo+J&cauthor_id=42663904)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-3 "Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain."), [Eduardo Albers Acosta](https://pubmed.ncbi.nlm.nih.gov/?term=Albers+Acosta+E&cauthor_id=42663904)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-4 "Department of Urology, University Hospital Basel, Basel, Switzerland."), [Pablo Rodríguez-Cortés](https://pubmed.ncbi.nlm.nih.gov/?term=Rodr%C3%ADguez-Cort%C3%A9s+P&cauthor_id=42663904)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-5 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#full-view-affiliation-6 "PhD Programme in Medicine and Surgery, Universidad Autónoma de Madrid, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es.") Affiliations Expand ### Affiliations * 1 Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain. * 2 Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. * 3 Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain. * 4 Department of Urology, University Hospital Basel, Basel, Switzerland. * 5 Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es. * 6 PhD Programme in Medicine and Surgery, Universidad Autónoma de Madrid, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es. * PMID: **42663904** * DOI: [ 10.1007/s10096-026-05648-5 ](https://doi.org/10.1007/s10096-026-05648-5) Item in Clipboard # Clinical and microbiological characteristics and outcomes of complicated urinary tract infections managed in a hospital-at-home programme: a prospective observational cohort study Lira Pelari-Mici et al. Eur J Clin Microbiol Infect Dis. 2026. Show details Display options Display options Format Abstract PubMed PMID Eur J Clin Microbiol Infect Dis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Clin+Microbiol+Infect+Dis%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Clin+Microbiol+Infect+Dis%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42663904/) . 2026 Aug 28. doi: 10.1007/s10096-026-05648-5. Online ahead of print. ### Authors [Lira Pelari-Mici](https://pubmed.ncbi.nlm.nih.gov/?term=Pelari-Mici+L&cauthor_id=42663904)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-1 "Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain."), [Elena Arranz Canales](https://pubmed.ncbi.nlm.nih.gov/?term=Arranz+Canales+E&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Alexia Constanza Espiño Álvarez](https://pubmed.ncbi.nlm.nih.gov/?term=Espi%C3%B1o+%C3%81lvarez+AC&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Eva María Fernández Bermejo](https://pubmed.ncbi.nlm.nih.gov/?term=Fern%C3%A1ndez+Bermejo+EM&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Ángela Sánchez Juez](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%A1nchez+Juez+%C3%81&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Victoria Gutiérrez Gómez-Lus](https://pubmed.ncbi.nlm.nih.gov/?term=Guti%C3%A9rrez+G%C3%B3mez-Lus+V&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Fernando Ruiz Berraco](https://pubmed.ncbi.nlm.nih.gov/?term=Ruiz+Berraco+F&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Saida Alonso Marrero](https://pubmed.ncbi.nlm.nih.gov/?term=Alonso+Marrero+S&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [Jaime Bustos Carpio](https://pubmed.ncbi.nlm.nih.gov/?term=Bustos+Carpio+J&cauthor_id=42663904)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-2 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain."), [José Curbelo](https://pubmed.ncbi.nlm.nih.gov/?term=Curbelo+J&cauthor_id=42663904)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-3 "Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain."), [Eduardo Albers Acosta](https://pubmed.ncbi.nlm.nih.gov/?term=Albers+Acosta+E&cauthor_id=42663904)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-4 "Department of Urology, University Hospital Basel, Basel, Switzerland."), [Pablo Rodríguez-Cortés](https://pubmed.ncbi.nlm.nih.gov/?term=Rodr%C3%ADguez-Cort%C3%A9s+P&cauthor_id=42663904)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-5 "Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42663904/#short-view-affiliation-6 "PhD Programme in Medicine and Surgery, Universidad Autónoma de Madrid, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es.") ### Affiliations * 1 Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain. * 2 Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. * 3 Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain. * 4 Department of Urology, University Hospital Basel, Basel, Switzerland. * 5 Hospital-at-Home Unit, Hospital Universitario de La Princesa, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es. * 6 PhD Programme in Medicine and Surgery, Universidad Autónoma de Madrid, Madrid, Spain. pablo.rodriguezcortes@estudiante.uam.es. * PMID: **42663904** * DOI: [ 10.1007/s10096-026-05648-5 ](https://doi.org/10.1007/s10096-026-05648-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Purpose:** Complicated urinary tract infections (cUTIs) are a frequent indication for admission to Hospital-at-Home (HaH) and outpatient parenteral antimicrobial therapy (OPAT) programmes. We describe the clinical, urological and microbiological profile, antimicrobial treatment and outcomes of a cUTI cohort managed in a HaH unit, and explored, in an exploratory analysis, factors associated with the 30-day composite of unplanned readmission or death. **Methods:** Prospective observational single-centre cohort of 262 consecutive cUTI episodes managed in a tertiary HaH unit (March 2023-October 2025). Baseline, urological, microbiological, treatment and outcome variables were recorded prospectively. Bivariate comparisons and an exploratory multivariable logistic regression were used to examine associations with the composite endpoint. **Results:** Median age was 79.7 years (Q1-Q3 66.1-87.2); 76.0% had multimorbidity. Escherichia coli was the most frequent isolate (45.4%; 41.2% ESBL-producing, 95% CI 32.7-50.2%), and the overall rate of resistance-mechanism-positive isolates was 30.2% (95% CI 24.9-36.0%). Ertapenem (42.8%) and ceftriaxone (41.2%) were the most frequently used intravenous agents. Clinical cure occurred in 92.0% (95% CI 88.1-94.7%) of episodes and 5.3% (95% CI 3.2-8.8%) required unplanned transfer to conventional care, with no deaths during the HaH episode. Within 30 days, 11.5% of episodes (95% CI 8.1-15.9%) were followed by hospital readmission and 4.2% (95% CI 2.4-7.4%) by death (composite endpoint, 13.4%, 95% CI 9.8-18.0%). In exploratory, hypothesis-generating analyses limited by the small number of events, older age and prior urological manipulation were identified as potential factors associated with the composite endpoint (age: OR 1.05, 95% CI 1.01-1.10; prior urological manipulation: OR 2.98, 95% CI 1.12-7.98), with wide confidence intervals. **Conclusion:** In this single-centre, uncontrolled descriptive cohort, cUTI managed through HaH/OPAT was associated with high clinical cure and low unplanned transfer, despite a substantial burden of ESBL-producing organisms and other resistance-mechanism-positive isolates. Older age and prior urological manipulation emerged as potential markers associated with adverse outcomes, warranting further characterisation in larger, adequately powered cohorts before informing risk stratification at HaH admission. **Keywords:** Antimicrobial resistance; Antimicrobial stewardship; Complicated urinary tract infection; Extended-spectrum beta-lactamase; Hospital-at-home; Outpatient parenteral antimicrobial therapy. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of Hospital Universitario de La Princesa (protocol no. 5605, CEIm 12/24, 20 June 2024). Consent to participate: Given the observational design and the use of anonymised, prospectively recorded data from routine HaH care, the Research Ethics Committee waived the requirement for individual informed consent. Consent to publish: Not applicable. The manuscript does not contain any individual person’s data in any form (including any individual details, images or videos). Competing interests: The authors declare no competing interests. ## References 1. 1. Artero A, López-Cruz I, Aguilera JA et al (2024) recurrent urinary tract infections in older adults requiring hospitalization in an internal medicine ward. Microorganisms 12:2114. - [DOI](https://doi.org/10.3390/microorganisms12112114) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39597504/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/11596791/) 2. 1. Eliakim-Raz N, Babitch T, Shaw E et al (2019) risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: A Multicenter Retrospective Cohort Study (RESCUING Study Group). Clin Infect Dis Off Publ Infect Dis Soc Am 68:29–36. - [DOI](https://doi.org/10.1093/cid/ciy418) 3. 1. Broughton E, Bektas M, Colosia A et al (2025) A systematic literature review of the epidemiology of complicated urinary tract infection. Infect Dis Ther 14:1157–1181. - [DOI](https://doi.org/10.1007/s40121-025-01149-8) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40268815/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/12151984/) 4. 1. Babich T, Eliakim-Raz N, Turjeman A et al (2021) Risk factors for hospital readmission following complicated urinary tract infection. Sci Rep 11:6926. - [DOI](https://doi.org/10.1038/s41598-021-86246-7) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/33767321/) - [PMC](https://pmc.
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