{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:28:33Z","timestamp":1792452513232,"version":"4.5.0"},"reference-count":52,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Length of hospital stay (LOS) is a critical measure of healthcare efficiency. This study investigated factors contributing to prolonged LOS in adult patients with urinary tract infections (UTIs) in Lebanon and assessed microbial susceptibility patterns of causative pathogens. Methods: A retrospective cohort study was conducted across five Lebanese university hospitals (March 2022\u2013December 2023), analyzing 401 patients. Data on microbiological findings and the LOS were extracted from medical records. Statistical analyses, including descriptive statistics, bivariate tests (t-tests, ANOVA, and Pearson\u2019s correlation), and multiple linear regression (significance: p \u2264 0.05), were performed using IBM SPSS\u00ae 27. Results: The mean LOS was 5.85 \u00b1 2.41 days. Prolonged hospitalization was associated with patient-related factors (age, comorbidities, UTI type, specific symptoms, and multidrug-resistant infections) and treatment-related factors. Empirical use of carbapenems (\u03b2 = 0.783, p = 0.004) and fluoroquinolones (\u03b2 = 1.360, p = 0.014), along with inappropriate antibiotic prescriptions (\u03b2 = 0.609, p = 0.022), significantly extended the LOS. Conversely, antibiotic de-escalation based on culture results reduced the LOS (\u03b2 = \u22120.567, p = 0.029). Escherichia coli (61.8%) was the predominant pathogen, followed by Klebsiella pneumoniae (11.9%), Proteus mirabilis (7.8%), and Pseudomonas aeruginosa (7.5%). Notably, susceptibility to antibiotics showed a concerning decline. Conclusions: Inappropriate antibiotic prescriptions were linked to a prolonged LOS, emphasizing the need for judicious antimicrobial use. The positive impact of de-escalation supports culture-guided therapy. Declining antibiotic susceptibility highlights the urgency for robust antimicrobial stewardship programs (ASPs) and a national microbial resistance database to combat antimicrobial resistance (AMR) in Lebanon.<\/jats:p>","DOI":"10.3390\/antibiotics14040421","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T20:42:00Z","timestamp":1745268120000},"page":"421","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Unraveling the Length of Hospital Stay for Patients with Urinary Tract Infections: Contributing Factors and Microbial Susceptibility"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4245-9699","authenticated-orcid":false,"given":"Deema","family":"Rahme","sequence":"first","affiliation":[{"name":"Ecole Doctorale des Sciences et des Technologies, Lebanese University, Hadat P.O. Box 6573\/14, Lebanon"},{"name":"Faculty of Pharmacy, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon"},{"name":"INSPECT-LB (Institut National de Sant\u00e9 Publique, d\u2019\u00c9pid\u00e9miologie Clinique et de Toxicologie\u2014Liban), Beirut P.O. Box 12109, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hania","family":"Nakkash Chmaisse","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Beirut Arab University, Beirut P.O. Box 11-5020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4780-0772","authenticated-orcid":false,"given":"Pascale","family":"Salameh","sequence":"additional","affiliation":[{"name":"INSPECT-LB (Institut National de Sant\u00e9 Publique, d\u2019\u00c9pid\u00e9miologie Clinique et de Toxicologie\u2014Liban), Beirut P.O. Box 12109, Lebanon"},{"name":"Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 36, Lebanon"},{"name":"Department of Primary Care and Population Health, University of Nicosia Medical School, 2417 Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Grey, B., Upton, M., and Joshi, L.T. (2023). Urinary tract infections: A review of the current diagnostics landscape. J. Med. Microbiol., 72.","DOI":"10.1099\/jmm.0.001780"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12937-022-00769-x","article-title":"Role of D-mannose in urinary tract infections\u2014A narrative review","volume":"21","author":"Laitila","year":"2022","journal-title":"Nutr. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1177\/00185787231160436","article-title":"Impact of Antimicrobial Stewardship Program Intervention Acceptance on Hospital Length of Stay","volume":"58","author":"Hurtado","year":"2023","journal-title":"Hosp. Pharm."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Eskandari, M., Alizadeh Bahmani, A.H., Mardani-Fard, H.A., Karimzadeh, I., Omidifar, N., and Peymani, P. (2022). Evaluation of factors that influenced the length of hospital stay using data mining techniques. BMC Med. Inform. Decis. Mak., 22.","DOI":"10.1186\/s12911-022-02027-w"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1001\/jama.1973.03220400035008","article-title":"Urinary tract infection: Practical aspects of diagnosis and treatment","volume":"225","author":"Fass","year":"1973","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.eimc.2012.11.015","article-title":"Infecciones del tracto urinario nosocomiales","volume":"31","author":"Pigrau","year":"2013","journal-title":"Enfermedades Infecc. Microbiol. Cl\u00ednica"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mancuso, G., Midiri, A., Gerace, E., Marra, M., Zummo, S., and Biondo, C. (2023). Urinary tract infections: The current scenario and future prospects. Pathogens, 12.","DOI":"10.3390\/pathogens12040623"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e135782","DOI":"10.5812\/archcid-135782","article-title":"Recent Data Characterizing the Prevalence and Resistance Patterns of FimH-producing Uropathogenic Escherichia coli Isolated from Patients with Urinary Tract Infections in North Lebanon","volume":"18","author":"Moubayed","year":"2023","journal-title":"Arch. Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"485","DOI":"10.11622\/smedj.2016153","article-title":"Urinary tract infections in adults","volume":"57","author":"Tan","year":"2016","journal-title":"Singap. Med. J."},{"key":"ref_10","first-page":"218431","article-title":"Escherichia coli Isolated from Urinary Tract Infections of Lebanese Patients between 2000 and 2009: Epidemiology and Profiles of Resistance","volume":"2011","author":"Daoud","year":"2011","journal-title":"Chemother. Res. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sokhn, E.S., Salami, A., El Roz, A., Salloum, L., Bahmad, H.F., and Ghssein, G. (2020). Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics. Med. Sci., 8.","DOI":"10.3390\/medsci8030032"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rahme, D., Ayoub, M., Shaito, K., Saleh, N., Assaf, S., and Lahoud, N. (2022). First trend analysis of antifungals consumption in Lebanon using the World Health Organization collaborating center for drug statistics methodology. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07883-5"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3201\/eid2804.211975","article-title":"Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017\u20132019","volume":"28","author":"Talaat","year":"2022","journal-title":"Emerg. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13756-019-0487-5","article-title":"A compilation of antimicrobial susceptibility data from a network of 13 Lebanese hospitals reflecting the national situation during 2015\u20132016","volume":"8","author":"Moghnieh","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s11096-020-01218-7","article-title":"Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016","volume":"43","author":"Lahoud","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"050","DOI":"10.23937\/2474-3658\/1510050","article-title":"Effect of Infection Prevention and Control Measures on the Length of Hospital Stay of Patients at Lebanese Hospitals","volume":"4","author":"Ahmad","year":"2018","journal-title":"J. Infect. Dis. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bologna, E., Licari, L.C., Manfredi, C., Ditonno, F., Cirillo, L., Fusco, G.M., Abate, M., Passaro, F., Di Mauro, E., and Crocetto, F. (2024). Carbapenem-Resistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therapeutic Alternatives. Medicina, 60.","DOI":"10.3390\/medicina60020214"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/bco2.286","article-title":"Fluoroquinolone resistance in urinary tract infections: Epidemiology, mechanisms of action and management strategies","volume":"5","author":"Thompson","year":"2024","journal-title":"BJUI Compass"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.vhri.2021.03.001","article-title":"Economic burden of urinary tract infections from antibiotic-resistant Escherichia coli among hospitalized adult patients in Lebanon: A prospective cohort study","volume":"25","author":"Iskandar","year":"2021","journal-title":"Value Health Reg. Issues"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/0974-777X.93755","article-title":"International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital","volume":"4","author":"Rosenthal","year":"2012","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/10892532231159723","article-title":"Length of Hospital Stay as a Performance Metric\u2014Is That a Fair Assessment?","volume":"27","author":"Pahwa","year":"2023","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zilberberg, M.D., Nathanson, B.H., Sulham, K., and Shorr, A.F. (2022). Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018. Open Forum Infectious Diseases, Oxford University Press.","DOI":"10.1093\/ofid\/ofab591"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/00185787231159578","article-title":"Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments","volume":"58","author":"Ingalls","year":"2023","journal-title":"Hosp. Pharm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jhin.2021.02.026","article-title":"Impact of healthcare-associated infection on length of stay","volume":"114","author":"Stewart","year":"2021","journal-title":"J. Hosp. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Arefian, H., Hagel, S., Fischer, D., Scherag, A., Brunkhorst, F.M., Maschmann, J., and Hartmann, M. (2019). Estimating extra length of stay due to healthcare-associated infections before and after implementation of a hospital-wide infection control program. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217159"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13561-023-00435-w","article-title":"The fragile healthcare system in Lebanon: Sounding the alarm about its possible collapse","volume":"13","year":"2023","journal-title":"Health Econ. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1097\/MLR.0000000000001059","article-title":"Measuring and Analyzing Length of Stay in Critical Care Trials","volume":"57","author":"Harhay","year":"2019","journal-title":"Med. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"344","DOI":"10.7861\/clinmedicine.13-4-344","article-title":"The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes","volume":"13","author":"Fielding","year":"2013","journal-title":"Clin. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3042","DOI":"10.19082\/3042","article-title":"Factors affecting length of stay in teaching hospitals of a middle-income country","volume":"8","author":"Khosravizadeh","year":"2016","journal-title":"Electron. Physician"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chen, Y.-P., Tasi, X.-W., Chang, K., Cao, X.-D., Chen, J.-R., and Liao, C.-S. (2021). Multi-Drug Resistant Organisms Infection Impact on Patients Length of Stay in Respiratory Care Ward. Antibiotics, 10.","DOI":"10.3390\/antibiotics10050608"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1093\/cid\/cit688","article-title":"Appropriate Antibiotic Use for Patients With Urinary Tract Infections Reduces Length of Hospital Stay","volume":"58","author":"Spoorenberg","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.euros.2022.07.009","article-title":"Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report","volume":"44","author":"Bonkat","year":"2022","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s40121-024-00973-8","article-title":"Treatment Patterns and Adherence to Guidelines for Uncomplicated Urinary Tract Infection in Germany: A Retrospective Cohort Study","volume":"13","author":"Krinner","year":"2024","journal-title":"Infect. Dis. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.ijantimicag.2019.06.015","article-title":"Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: Results of an online survey","volume":"54","author":"Malmros","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"339","DOI":"10.4103\/UA.UA_104_19","article-title":"Management of urinary tract infection in women: A practical approach for everyday practice","volume":"11","author":"Degheili","year":"2019","journal-title":"Urol. Ann."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ofid\/ofy346","article-title":"The Importance of Antimicrobial Resistance Monitoring Worldwide and the Origins of SENTRY Antimicrobial Surveillance Program","volume":"6","author":"Fuhrmeister","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_37","unstructured":"WHO (2022). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022."},{"key":"ref_38","unstructured":"EARS-Net (2022). Surveillance of Antimicrobial Resistance in Europe\u2014Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s44280-023-00009-9","article-title":"Current status and trends of antimicrobial resistance among clinical isolates in China: A retrospective study of CHINET from 2018 to 2022","volume":"1","author":"Yang","year":"2023","journal-title":"One Health Adv."},{"key":"ref_40","unstructured":"CDC (2019). Antibiotic Resistance Threats in the United States."},{"key":"ref_41","first-page":"100705","article-title":"Challenges and opportunities for incentivising antibiotic research and development in Europe","volume":"33","author":"Anderson","year":"2023","journal-title":"Lancet Reg. Health\u2014Eur."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.jhin.2018.07.009","article-title":"First Lebanese Antibiotic Awareness Week campaign: Knowledge, attitudes and practices towards antibiotics","volume":"101","author":"Wrayde","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Kabbara, W.K., Meski, M.M., Ramadan, W.H., Maaliki, D.S., and Salameh, P. (2018). Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon. Can. J. Infect. Dis. Med. Microbiol., 2018.","DOI":"10.1155\/2018\/7404095"},{"key":"ref_44","first-page":"27094","article-title":"Evaluation of antibiotic prescription in the Lebanese community: A pilot study","volume":"5","author":"Saleh","year":"2015","journal-title":"Infect. Ecol. Epidemiol."},{"key":"ref_45","first-page":"49","article-title":"Community Usage Pattern of Antibiotics within Lebanese Population: A Prospective Study","volume":"5","author":"Khalifeh","year":"2017","journal-title":"Am. J. Pharmacol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s43994-024-00153-x","article-title":"Sample size calculation in biomedical, clinical and biological sciences research","volume":"11","author":"Sadiq","year":"2024","journal-title":"J. Umm Al-Qura Univ. Appl. Sci."},{"key":"ref_47","unstructured":"CDC (2025, March 20). Immunocompromised Definition: Centers for Disease Control and Prevention, Available online: https:\/\/nhsn.cdc.gov\/nhsntraining\/courses\/pneu\/index.html?jmptopg=page5468.html#top."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1128\/AAC.39.6.1211","article-title":"A functional classification scheme for beta-lactamases and its correlation with molecular structure","volume":"39","author":"Bush","year":"1995","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Sanchez, E., and Doron, S. (2017). Bacterial Infections: Overview, Elsevier.","DOI":"10.1016\/B978-0-12-801238-3.03000-2"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"208","DOI":"10.12816\/0042765","article-title":"The Lebanese Society of Infectious Diseases and Clinical Microbiology: Guidelines for the Treatment of Urinary Tract Infections","volume":"65","author":"Husni","year":"2017","journal-title":"Leban. Med. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s10654-019-00494-6","article-title":"Principles of confounder selection","volume":"34","author":"Vanderweele","year":"2019","journal-title":"Eur. J. Epidemiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/4\/421\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:18:56Z","timestamp":1760030336000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/4\/421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,21]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["antibiotics14040421"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14040421","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,21]]}}}