Clinical, microbiological and antimicrobial resistance profile of complicated urinary tract infections managed in a Hospital-at-Home programme: a prospective observational cohort study

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 (IQR 21.1); 76.0% had multimorbidity. Escherichia coli was the most frequent isolate (45.4%; 41.2% ESBL-producing), and the overall multidrug-resistance rate was 30.2%. Ertapenem (42.8%) and ceftriaxone (41.2%) were the most frequently used intravenous agents. Clinical cure occurred in 92.0% of episodes and 5.3% required unplanned transfer to conventional care, with no deaths during the HaH episode. Within 30 days, 11.5% of episodes were followed by hospital readmission and 4.2% by death (composite endpoint, 13.4%). In an exploratory multivariable model with a limited number of events, older age and prior urological manipulation showed a statistically significant association with the composite endpoint (age: OR 1.05, 95% CI 1.01–1.10; prior urological manipulation: OR 2.93, 95% CI 1.05–8.21), 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 and multidrug-resistant organisms. Systematic assessment of geriatric vulnerability and urological complexity, particularly prior urological manipulation and indwelling bladder catheterisation, may help refine risk stratification at HaH admission and during follow-up.