Failure Rate of Oral Nitrofurantoin in Treating UTIs caused by ESBL-Producing Escherichia coli and Klebsiella pneumoniae : A Retrospective Cohort Study
Bibliographic record
Abstract
Background:Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms limit oral treatment options. Nitrofurantoin is frequently used, but regional data on its activity against ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) are lacking in Saudi Arabia. This study aimed to determine the 90-day failure rate of oral nitrofurantoin in treating ESBL-UTIs and explore secondary outcomes. Methods:This was a retrospective cohort study conducted at a tertiary hospital in Riyadh, Saudi Arabia. The target population was adult ED patients, discharged on oral nitrofurantoin for UTIs caused by ESBL-EC or ESBL-KP, between February 2021 and June 2024. We aimed to identify the failure rate of oral nitrofurantoin in this population. Treatment failure was defined as any ESBL-positive urine culture within 90 days of treatment initiation. Results:Among 13,421 UTI cases, 347 (2.6%) were ESBL-positive; 41 received oral nitrofurantoin, and 18 met the final inclusion criteria. The 90-day recurrence rate was 22.2% (4/18), with 77.8% having no early recurrence. Three patients had recurrence between 90–180 days. Half of all nitrofurantoin-treated patients were later hospitalized, with severe cases requiring ICU. Conclusion:Nitrofurantoin showed a 22% failure rate in treating ESBL-UTIs, yet remained effective in most cases, especially those involving ESBL-EC. Given its accessibility, nitrofurantoin remains a viable option but requires close follow-up. Larger studies are needed to refine its role in ESBL-UTI management.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".