{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:09:44Z","timestamp":1787846984874,"version":"build-2784847793"},"reference-count":25,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background: Resistant bacteria causing urinary tract infections (UTI) are becoming increasingly common worldwide. Patients suffering from such UTIs are often elderly, with complex medical backgrounds, and require prolonged hospital stays due to the frequent need for intravenous antibiotics. The alternative hospital-at-home (HAH) option for such patients should, therefore, be explored. Methods. We present our experience in the treatment of patients with extended-spectrum beta-lactamase (ESBL) infections treated through our HAH service. Results: Eleven such patients were included in our HAH service between February 2022 and December 2023 (median age: 79 years; 64% females; 57% had diabetes mellitus in their background). Of these patients, 27.2% had urinary instrumentations and 81.8% had a history of previous UTIs, of which 77.7% had resistant bacteria. The most common pathogen (7 out of 9 patients) was Escherichia coli. All eleven pathogens were resistant to ceftriaxone and ciprofloxacin. The mean length of hospitalization was 5 \u00b1 2 days. Eight patients (72.7%) did not experience recurrent UTIs. Only two patients (18.2%) experienced acute kidney injury, which resolved during their HAH stay. Two patients died during a 30-day follow up from causes unrelated to their UTI. Conclusions: Treatment of patients presenting with urinary tract infections with resistant ESBL pathogens in the setting of a telemedicine-assisted, hospital-at-home setting is both effective and safe.<\/jats:p>","DOI":"10.3390\/reports7020031","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T05:13:41Z","timestamp":1714108421000},"page":"31","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Safe and Effective Treatment of Patients with Urinary Tract Infections Caused by Extended-Spectrum Beta Lactamase-Producing Enterobacteriaceae via Telemedicine-Controlled Hospital at Home: A Case Series of 11 Patients"],"prefix":"10.3390","volume":"7","author":[{"given":"Mayan","family":"Gilboa","sequence":"first","affiliation":[{"name":"Infection Prevention Unit, Sheba Medical Center, Ramat Gan 5262000, Israel"},{"name":"Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel"},{"name":"Education Authority, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sholem","family":"Hack","sequence":"additional","affiliation":[{"name":"St. Georges University London School of Medicine, Program Delivered by University of Nicosia at the Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahar","family":"Hochner","sequence":"additional","affiliation":[{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gitbinder","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, Palacky University Olomouc, 78371 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megi","family":"Yakovlev","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, Palacky University Olomouc, 78371 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5622-6146","authenticated-orcid":false,"given":"Noa","family":"Bineth","sequence":"additional","affiliation":[{"name":"Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9002002, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galia","family":"Barkai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel"},{"name":"Beyond Virtual Hospital, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3851-3245","authenticated-orcid":false,"given":"Gad","family":"Segal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel"},{"name":"Education Authority, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"},{"name":"St. Georges University London School of Medicine, Program Delivered by University of Nicosia at the Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"},{"name":"Beyond Virtual Hospital, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.molmed.2016.09.003","article-title":"Urinary Tract Infection: Pathogenesis and Outlook","volume":"22","author":"McLellan","year":"2016","journal-title":"Trends. Mol. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s42770-023-00942-2","article-title":"Bacterial profile, antimicrobial resistance, and molecular detection of ESBL and quinolone resistance gene of uropathogens causing urinary tract infection in the southeastern part of Bangladesh","volume":"54","author":"Sultana","year":"2023","journal-title":"Braz. J. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/1120009X.2017.1380395","article-title":"Multi-drug-resistant Gram-negative bacteria causing urinary tract infections: A review","volume":"29","author":"Mazzariol","year":"2017","journal-title":"J. Chemother."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Critchley, I.A., Nicole Cotroneo Pucci, M.J., and Mendes, R. (2019). The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017. PLoS ONE, 14.","DOI":"10.1101\/703199"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jhin.2015.10.001","article-title":"Impact of infection with extended-spectrum \u03b2-lactamase-producing Escherichia coli or Klebsiella species on outcome and hospitalization costs","volume":"92","author":"Maslikowska","year":"2015","journal-title":"J. Hosp. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.jinf.2015.08.012","article-title":"Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: A matched cohort study","volume":"71","author":"Solande","year":"2015","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.2147\/IDR.S204880","article-title":"Community acquired urinary tract infections among adults in Accra, Ghana","volume":"12","author":"Donkor","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Geerlings, S.E. (2016). Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol. Spectr., 4, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/27780014\/.","DOI":"10.1128\/microbiolspec.UTI-0002-2012"},{"key":"ref_9","unstructured":"Sabih, A., and Leslie, S.W. (2023). Complicated Urinary Tract Infections. StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK436013\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/S1684-1182(10)60031-X","article-title":"Impact of Extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections","volume":"43","author":"Yang","year":"2010","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"242","DOI":"10.5694\/mja2.51375","article-title":"Hospital-acquired complications: The relative importance of hospital- and patient-related factors","volume":"216","author":"Duke","year":"2022","journal-title":"Med. J. Aust."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Haskel, O., Itelman, E., Zilber, E., Barkai, G., and Segal, G. (2022). Remote Auscultation of Heart and Lungs as an Acceptable Alternative to Legacy Measures in Quarantined COVID-19 Patients\u2014Prospective Evaluation of 250 Examinations. Sensors, 22.","DOI":"10.3390\/s22093165"},{"key":"ref_13","first-page":"200215","article-title":"Occult myocardial injury is prevalent amongst elderly patients in the hospital-at-home setting. A retrospective analysis of 213 patients","volume":"19","author":"Marziano","year":"2023","journal-title":"Int. J. Cardiol. Cardiovasc. Risk Prev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1017\/S0266462318000454","article-title":"Costs of home-based telemedicine programs: A systematic review","volume":"34","author":"Michaud","year":"2018","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1287\/isre.2020.0926","article-title":"Does Telemedicine Reduce Emergency Room Congestion? Evidence from New York State","volume":"31","author":"Sun","year":"2020","journal-title":"Inf. Syst. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/S0140-6736(99)03428-5","article-title":"Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: A randomised controlled study","volume":"354","author":"Stewart","year":"1999","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/ageing\/afi206","article-title":"Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial)","volume":"35","author":"Caplan","year":"2006","journal-title":"Age Ageing"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wolterink, I., Verheij, T., Platteel, T., Bruel Van Den, A., Stam, A., and Pol Van De, A. (2020). Nitrofurantoin Failure in Elderly Men: A Retrospective Observational Study. Antibiotics, 9.","DOI":"10.3390\/antibiotics9050211"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5099","DOI":"10.1128\/AAC.00565-10","article-title":"National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum beta-lactamases","volume":"54","author":"Marchaim","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e371","DOI":"10.1016\/j.ijid.2012.01.008","article-title":"Bloodstream infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary care hospital in New Zealand: Risk factors and outcomes","volume":"16","author":"Freeman","year":"2012","journal-title":"Int. J. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.2217\/fmb.12.100","article-title":"Detecting risk and predicting patient mortality in patients with extended-spectrum -lactamase-producing Enterobacteriaceae bloodstream infections","volume":"7","author":"Trecarichi","year":"2012","journal-title":"Future Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ijid.2015.03.006","article-title":"Urinary tract infections due to extended-spectrum beta-lactamase-producing Gram-negative bacteria: Identification of risk factors and outcome predictors in an Australian tertiary referral hospital","volume":"34","author":"Osthoff","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.ijregi.2022.05.001","article-title":"Epidemiology of urinary tract infection in adults caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae\u2014A case\u2013control study from Qatar","volume":"3","author":"Naushad","year":"2022","journal-title":"IJID Reg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/2047-2994-3-9","article-title":"Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria","volume":"3","author":"Kassakian","year":"2014","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1001\/jamainternmed.2016.5974","article-title":"Alternative Strategies to Inpatient Hospitalization for Acute Medical Conditions: A Systematic Review","volume":"176","author":"Conley","year":"2016","journal-title":"JAMA Intern. Med."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/2\/31\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:33:37Z","timestamp":1760106817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/2\/31"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["reports7020031"],"URL":"https:\/\/doi.org\/10.3390\/reports7020031","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]}}}