Cost-effectiveness of intravenous resuscitation fluids in sepsis patients: a patient-level data analysis in Jordan.

AIM: Albumin role as fluid resuscitation in sepsis remains understudied in low- and middle-income countries. This study aimed to evaluate the cost-effectiveness of intravenous (IV) Albumin compared to Crystalloids in sepsis patients using patient-level data in Jordan. METHODS: This was a retrospective cohort study of sepsis patients aged 18 or older admitted to intensive care units (ICU) at two major tertiary hospitals during the period 2018-2019. Patients information, type of IV fluid, and clinical outcomes were retrieved from medical records, and charges were retrieved from the billing system. A 90-day partitioned survival model with two health states (alive and dead) was constructed to estimate the survival of sepsis patients receiving either Albumin or Crystalloids as IV fluids for resuscitation. Overall survival was predicted by fitting a Weibull model on the patient-level data from the current study. To further validate the results, and to support the assessment of uncertainty, time-dependent transition probabilities of death at each cycle were estimated and used to construct a state-transition patient-level simulation model with 10,000 microsimulation trials. Adopting the healthcare system perspective, incremental cost-effectiveness ratios(ICERs) of Albumin versus Crystalloids were calculated in terms of the probability to be discharged alive from the ICU. Uncertainty was explored using probabilistic sensitivity analysis. RESULTS: In the partitioned survival model, Albumin was associated with an incremental cost of $1,007 per incremental1% in the probability of being discharged alive from the ICU. In the state-transition patient-level simulation model, ICER was $1,268 per incremental 1% in the probability of being discharged alive. Probabilistic sensitivity analysis showed that Albumin was favored at thresholds >$800 per incremental 1%in the probability of being discharged alive from the ICU. CONCLUSION: IV Albumin use in sepsis patients might not be cost-effective from the healthcare perspective of Jordan. This has important implications for policymakers to readdress Albumin prescribing practice in sepsis patients.

Sepsis is a life-threatening complication of infection, which usually requires resuscitation with intravenous fluids. Still, no conclusive evidence is available about the best fluid resuscitation to be used in sepsis patients especially in low- and middle-income countries. This study compared the costs and effectiveness of intravenous Albumin versus Crystalloids in sepsis patients. Findings from this study showed that resuscitation with Albumin is much more expensive compared to resuscitation with Crystalloids with no significant difference in mortality but with prolonged length of stay in the hospital and the intensive care unit. Decision makers are advised to change Albumin prescribing practices in a way that mitigates the associated clinical and financial burdens without compromising quality of care or resuscitate with Crystalloids.

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

Background: Despite reduced infectious disease mortality and improved survival, infectious diseases continue to pose health threats due to their contagiousness, societal harm, and morbidity. Empiric antibiotic therapy, often prescribed without knowledge of the causative pathogen, faces challenges from rising antibiotic resistance. This study explores the potential of prior positive culture results to guide empiric antibiotic therapy. Methods: Data from King Abdullah University Hospital (Jan 2014-Dec 2019) included adult patients with recurrent bacterial infections (pneumonia, sepsis, UTIs, wounds). Excluded cases included: mixed infections, transfers, <14 days or >12 months between episodes. The study compared bacterial growth and sensitivity patterns between previous and recent cultures. Results: The study included 970 episodes from 650 patients, mainly UTIs (60.3%) and gram-negative bacteria (77.9%). The study found that (65.1%) of culture pairs matched. Empirical therapy was accurate in (71.8%) of cases. Further, accuracy of selected empiric antibiotic therapy was significantly predicted (p â€‹< â€‹0.001) by: type of infection, type of antibiotics, and concordance with prior microbiologic data. Multivariate logistic analysis showed blood culture as less predictive of pending identity (OR: 0.234, P â€‹< â€‹0.001) compared to urine culture; and prior affirmed gram negative bacterial culture was less predictive (OR: 0.606, P â€‹= â€‹0.021) compared to gram positive bacterial culture. Conclusion: This study underscores the potential of prior positive culture results in guiding empiric antibiotic therapy, enhancing accuracy and identity agreement. Future research should explore this approach in different infection contexts and across multiple centers. Reducing the indiscriminate use of broad-spectrum antibiotics is essential to combat antibiotic resistance.

Clinical and economic outcomes associated with intravenous albumin fluid use in the intensive care unit: a retrospective cohort study.

OBJECTIVES: This study was undertaken to evaluate the prescribing practice of albumin in the intensive care unit (ICU) and to compare the clinical and economic outcomes associated with intravenous (IV) albumin compared to crystalloids in the ICU. METHODS: This was a retrospective cohort study of ICU adult patients admitted to King Abdullah University Hospital during 2018-2019. Patient demographics, clinical characteristics, and admission charges were retrieved from medical records and billing system. Survival analysis, multivariable regression models, and propensity score matching estimator were performed to evaluate the impact of IV resuscitation fluid types on the clinical and economic outcomes. RESULTS: Albumin administration in the ICU was associated with significantly lower hazards of ICU death (HR = 0.57; P value <0.001), but without improving overall death probability compared to crystalloids. Albumin was associated with significant prolongation in the ICU length of stay (5.86 days; P value <0.001). Only 88 patients (24.3%) were prescribed albumin for Food and Drug Administration (FDA)-approved indications. Admission charges were significantly higher for patients treated with albumin (p value <0.001). CONCLUSIONS: IV Albumin use in the ICU was not associated with significant improvement in clinical outcomes, but with a remarkable increase in economic burden. The majority of patients received albumin for non-FDA-approved indications.

General Public Perceptions and Perceived Barriers Toward the Use of Telehealth: A Cross-Sectional Study from Jordan.

Background: Telemedicine implies the provision of health care services, such as diagnosis, treatment, and consultation related to different disease states remotely through harnessing a variety of technologies. Aim: Despite the widespread global applications related to telehealth, there are limited research articles exploring the perceptions and barriers related to telehealth implementation in developing countries such as Jordan. Thus, this study was conducted to explore general public perceptions regarding the provision of health care services through different technological devices and to examine perceived barriers and facilitators. Methods: A cross-sectional study was conducted for 6 months. Participants were recruited through different social media portals. A convenient sample from the Jordanian population was approached. A total of 1,136 responses were collected and included in the final analysis, which was done by the Statistical Package for Social Sciences (SPSS version 25). Results: A total of 1,136 responses were valid for further analysis. The results of this study expressed that the public has positive perceptions toward the use of telemedicine with the majority being capable of using telehealth based on having an active internet connection, technological devices, and the ability to use social media accounts or instant messaging services. Logistic regression analysis revealed that those with comorbid diseases and higher summated capability scores (p = -0.017 and p < 0.001, respectively) had a statistically significant relationship with willingness to use telehealth as reflected by stating a clear intention to use telehealth services once available. Conclusion: In conclusion, the Jordanians had positive perceptions toward the use of telehealth services. However, their willingness to use telehealth services was affected by limited knowledge about the service. Telehealth offers the opportunity to provide quality care and improve patient outcomes, especially for the inhabitants of rural areas or in cases where access to health care facilities is compromised such as pandemics.

Perceptions toward the use of over-the-counter dietary supplements during the coronavirus disease 2019 pandemic: A cross sectional study of the general public in Jordan.

Background and Aims: Over-the-counter (OTC) dietary supplements gained popularity during the COVID-19 pandemic as a preventive measure. Lack of complete understanding among the general population of the pathophysiologic mechanisms underlying the severity and progression of infection with coronavirus disease 2019 (COVID-19) has further encouraged the use of supplements. The present study aimed to assess the perceptions of the general public toward the efficacy and safety of the use of OTC dietary supplements as immune enhancers during the COVID-19 pandemic. The factors impacting these perceptions were also explored. Methods: This was an online survey-based, cross-sectional study conducted in Jordan over 4 months. A validated survey which comprised 28 questions covering aspects related to the respondents' demographic characteristics, their perceptions toward the efficacy of OTC dietary supplements and their awareness regarding the safety of popular OTC supplements and healthy dietary habits was used to collect responses. Associations between patient characteristics with perception and awareness were explored. Results: A total of 1487 responses were included in the analysis. Ascorbic acid, zinc, and vitamin D were the most popular OTC supplements, as indicated by the percentages of users (48.8%, 38.6%, and 34.6%, respectively). Perceptions toward OTC supplement use were suboptimal, with a reported mean perception score of 27.82 ± 8.56 (range 0-45). The multivariate analysis showed that participants who were of older age (>65 years) (AOR = 6.29, 95% CI = 2.2-17.9), had an income level >1500 (AOR = 1.84, 95% CI = 1.80-3.56), and used chronic medications had better perceptions than did younger participants, those with no income, and non-users of chronic medications, respectively. The mean safety awareness score was 5.36 ± 1.58 (maximum 7), with a significant direct relationship identified between perceptions and safety awareness scores (Spearman's correlation = 0.136, p < 0.001). Conclusion: This study highlighted the needs to organize educational campaigns that promote general public perceptions toward the safe use of OTC supplements to enhance immunity during COVID-19.

Healthcare Providers' Perspectives Toward the Integration of over the Counter Supplements During COVID-19 Pandemic: A Cross-Sectional Study from Jordan.

Objective: During COVID-19 pandemic, healthcare providers (HCPs) have been inundated with consultations related to over the counter (OTC) dietary supplements' protective role. Thus, the present study focused on assessing HCPs perceptions toward OTC products integration during the COVID-19 outbreak. Methods: Pertinent data was collected using validated-online survey comprising four sections: demographics, OTC supplementation perceptions, awareness related to safety of OTC supplements, confidence in recommending dosage and counseling to patients regarding OTC supplements' safety, and some health-related behaviors. Quantified perception score represented by corrected confidence-concern ratio was used in assessing perceptions, and associations between demographics with perception and awareness were explored. Results: A total of 600 responses were included in the final analysis. Vitamin C, zinc, and vitamin D were the most popularly recommended OTC supplements. Most respondents indicated positive perceptions toward dietary supplementation while around 60% of respondents reported reluctance about the protective role of COVID-19 vaccination. Bachelor's degree holders (AOR = 4.39, 95% CI = 2.25-10.33), pharmacists (AOR = 2.17, 95% CI = 1.5-9.5), and junior HCPs (<1 year experience) had improved perceptions compared to college graduates, physicians, and senior practitioners (AOR = .17, 95% CI = .04-.78 and AOR = .15, 95% CI = .02-.93), respectively. Conclusion: Suboptimal knowledge among HCPs toward the safety and hazards associated with integration of different OTC supplements during the COVID-19 pandemic dictates further education to ensure the safe integration of OTC supplements.

Prevalence and predictors of non-adherence to short-term antibiotics: A population-based survey.

Non-adherence to antibiotics is a well-known, core player to antibiotic resistance. The current adherence behavior toward short-term antibiotic regimens has never been investigated before in Jordan. This study assessed the prevalence and predictors of non-adherence to short-term antibiotics among Jordanians and investigated participants' views about different reasons related to antibiotics non-adherence. A cross-sectional face-to-face survey-based interview was conducted in three hospital pharmacies in Jordan. Adults and mother of children (≤12 years old) who completed their short course treatment (<30 day) of oral antibiotic within the last month were recruited. A total of 2000 participants (adults: 1000 and mothers of children: 1000) were included in the study with a response rate of 91.60%. The prevalence of non-adherence was estimated to be 32.10%. Non-adherent respondents scored a lower Medication Adherence Report Scale [16.76±5.02 vs. 23.04 ±3.24] than adherent respondents (p<0.001). Adults without comorbidity and children with higher number of doses per regimen were significantly less adherent to antibiotic [(OR = 0.615, 95%CI = 0.444-0.853, p = 0.004) and (OR = 0.965, 95%CI = 0.950-0.981, p<0.001)], respectively. Patients-related factors were the most common antibiotic non-adherence reason reported by the participants. The multivariate analysis for all the participants (adults and children), indicated that mothers were 2.6 times more likely to be adherent in giving antibiotics to their children than adults (p<0.001). These findings highlight that more than half of the participants were adherent to short-term antibiotics. However, improving the current prescription-related practices and implementing pharmaceutical consultation services upon antibiotic dispensing are encouraged.

Assessment of the relationship between COVID-19 risk perception and vaccine acceptance: a cross-sectional study in Jordan.

BACKGROUND: In the absence of definitive treatment, vaccination against COVID-19 emerged as an effective solution to the spread of the pandemic. This study aimed to investigate the factors impacting the rates of COVID-19 vaccine acceptance in Jordan, in addition to examining the relationship between COVID-19 risk perception and vaccine acceptance among the Jordanian population. METHODS: This cross-sectional study was conducted among a sample of adults (aged ≥18) residing in Jordan. Data were collected using an online questionnaire disseminated using social media platforms between December 2nd and December 29th, 2020. RESULTS: A total of 2,268 (72.3%) participants demonstrated willingness to receive the COVID-19 vaccine. The mean COVID-19 risk perception score among the participants was 4.65 out of 10 (median 5; IQR 3-6). Higher risk perception scores were significantly associated with being female (p = .001), young (p < .001), or a smoker (p = .005). A significant positive correlation was identified between COVID-19 vaccine acceptance and risk perception scores (OR = 1.319, 95%, CI = 1.261-1.380, p < .001). Moreover, male participants (75%, OR = 1.220, 95% CI = 1.007-1.479, p = .043), participants aged 18-24 years (78.1%, OR = 1.635, 95% CI = 1.189-2.246, p = .002), and participants with children aged under 18 years (73.9%, OR = 1.210, 95% CI = 1.010-1.450, p = .039) were more willing than their counterparts to get vaccinated. CONCLUSION: COVID-19 risk perception and certain sociodemographic characteristics (i.e., being male, being young, and having children aged under 18 years) were found to be significantly associated with vaccine acceptance. Policymakers are recommended to develop public educational campaigns to enhance people's trust in and willingness to take the COVID-19 vaccine.

Clinical and economic impact of telemedicine in the management of pediatric asthma in Jordan: a pharmacist-led intervention.

OBJECTIVE: Pediatric asthma is a major public health concern, considering its chronic nature and negative effects on quality of life of affected children. Telemedicine is efficacious in providing pharmaceutical care for patients with several chronic diseases, including asthma. This approach allows habitants of sparsely populated rural Jordanian areas to remotely access high-quality healthcare services. Pharmacist-provided asthma counseling has proven benefits in improving patient adherence rates and their understanding. This study evaluated clinical and economic impacts of pharmacist-led, interactive synchronous telemedicine counseling of pediatric asthma patients in Jordan. METHODS: A randomized, controlled, 12-week pre-post interventional study was conducted. Ninety patients with uncontrolled asthma aged 5-11 years were recruited and randomly assigned to two groups: intervention or control. Inhaler use was checked for both groups at baseline, along with assessment of clinical and economic measures. Counseling on proper inhaler use was provided by pharmacists. Telemedicine sessions for the intervention group were scheduled every 4 weeks, whereas the control group received standard care. Pertinent measures reflecting the level of disease control and relapse were tracked monthly. RESULTS: The intervention group showed more significant improvement in clinical and economic outcomes than the control group (the Childhood Asthma Control Test mean scores [P = 0.0134], decreased parental loss of wages [P = 0.0015], and decreased economic burden [P < 0.001]). Additionally, overall improvement in quality of life and satisfaction with the telemedicine sessions were reported. CONCLUSION: Pharmacist-led telemedicine counseling could be a promising approach to deliver distant pharmaceutical care for patients with childhood asthma.

The Association Between e-Health Literacy and Willingness to Deprescribe Among Patients with Chronic Diseases: A Cross-Sectional Study from Jordan.

Background: Deprescribing refers to the partnered discontinuation of chronic medications to limit the negative impacts of polypharmacy. Polymedicated patients play a key role in the success of deprescribing efforts. eHealth literacy reflects patients' ability to appraise electronically available health-related information to make informed health care decisions, which partly reflect their desire to deprescribe. Objectives: The current study aimed to explore the relationship between eHealth literacy and willingness to deprescribe among patients with chronic diseases. Additionally, the predictors of willingness to deprescribe were examined. Materials and Methods: This cross-sectional study was conducted among adult patients with chronic diseases in Jordan. An online questionnaire comprising two validated tools, namely the Electronic Health Literacy Scale (eHEALS) and the Revised Patients' Attitudes Toward Deprescribing (rPATD) Questionnaire, was used for data collection. The questionnaire targeted adult patients with chronic medical conditions in Jordan and was posted to social media portals, following a convenience sampling technique. Results: A total of 719 responses were recorded and included in the final analysis. Participants with higher levels of eHealth literacy were more willing to get their medications deprescribed, as indicated by the perceived use of unneeded medications (p = 0.042). Meanwhile, participants with low levels of eHealth literacy were more likely to report fear of missing out on the potential benefits of deprescribed medications (p = 0.003). Other items that were commonly agreed upon by both the low and high eHealth literacy groups, respectively, included desire for dose reduction (p < 0.001, p < 0.001), belief in the lack of effectiveness of some prescribed medications (p < 0.001, p < 0.001), and fear of precipitating side effects (p = 0.001, p = 0.007). Conclusions: The present study highlighted the relationship between eHealth literacy and a number of items reflecting willingness to deprescribe, and these indicators can be used to guide future deprescribing efforts among eligible patients.

Exception from informed consent for biomedical research in emergency settings: A study from Jordan.

BACKGROUND: Research conduction in emergency settings is of paramount importance to promote knowledge and experiences related to treating acutely ill patients. However, the complexity of situations creates a considerable ethical challenge facing researchers who basically deal with emergent cases. This study aimed to determine attitudes of healthcare providers (HCPs) towards exception from informed consent (EFIC) and enrollment willingness in emergency research in Jordan. METHODS: A quantitative research with face-to-face questionnaire was conducted by an interviewer during 6-month period in 2019. Survey measures included items related to EFIC policy and overall willingness of HCPs to participate or support their family members' participation in emergency research. RESULTS: A total of 151 HCPs in the emergency departments (EDs) in Jordan was recruited. Positive attitude toward emergency research dominated among participants; about 21.9% of participants reported previous experience in the conduction of emergency research and 12.3% had related publications. Regarding EFIC policy, there was a general consensus of disagreement to most of the examined items. There was a trend for little support of EFIC policy when questioned about the enrollment of family members or public in emergency research, however, the application of EFIC was accepted for self-enrollment of respondents in emergency research. No significant differences (P = 0.37), among participants from different disciplines, were reported regarding the attitudes towards EFIC items or willingness to enroll in emergency research. CONCLUSIONS: Generally, HCPs reported an overall positive support to emergency research despite a consensus of disagreement related to EFIC terms. Therefore, it is recommended to pursue future studies to compare well-informed subjects; recruited from well-developed institutions in regard to emergency research potentials; with the present basic attitudinal surveillance in order to dissipate the effect of such confounder and to get better insight of the actual attitudes related to emergency research and EFIC. In addition, efficient multidisciplinary communication channels between researchers and policy makers can lather the way to collaborative research with simultaneous innovative delivery of quality emergency care.

Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases.

BACKGROUND: Hydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient's management and outcome even in endemic areas. CASE PRESENTATION: We herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up. The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up. CONCLUSIONS: Despite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.

Antibiotic prescribing patterns for childhood infections in ambulatory settings in Jordan.

BACKGROUND: Antibiotics' rational prescribing is a major goal of the World Health Organization's (WHO) global action plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of paediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. METHODS: A cross-sectional retrospective study was conducted by selecting a random sample of paediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age ≤18 years) receiving at least one antibiotic were included. The WHO's model of drug utilisation was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. RESULTS: A total of 20 494 prescriptions, containing 45 241 prescribed drugs, were obtained. The average number of prescribed drugs per prescription was (2.21 ± 0.98). Approximately 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic names and from the essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season and facility type were significant predictors of prescribed antibiotics to overall medications ratio. CONCLUSIONS: This is the first study of antibiotic prescribing patterns among outpatient paediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient paediatrics. Such findings necessitate more focussed efforts and regulations that support rational utilisation of drugs.

Paediatric asthma exacerbation admissions and stringency of non-pharmaceutical interventions: Results from a developing country.

BACKGROUND: Non-pharmaceutical interventions (NPI) mitigation measures implemented to mitigate COVID-19 has brought unprecedented global impact. Changes in daily living routines, reduction in physical activities, and changes in environmental indicators were suggested to positively impact paediatric asthma indicators in western cultures. Little is known about such impact in developing countries. This study investigated the potential impact of COVID-19 NPI measures on paediatric asthma exacerbation admissions in Northern Jordan. METHODS: Aggregate data from a paediatric hospital, Princess Rahma Pediatric Teaching Hospital, and King Abdulla University Teaching Hospital were utilised from 2018 to 2020. The number of paediatric asthma exacerbation admissions was calculated by week and compared by year, lockdown status, and weeks for lockdown (weeks 13-19). The stringency index was correlated with the number of weekly paediatric asthma exacerbation admissions for 2020. RESULTS: A total of 1,207 paediatric asthma exacerbation admissions were reported; 40.3%, 35.2%, and 24.5% in 2018, 2019 and 2020, respectively. The number of weekly admissions ranged from 1 to 13 paediatric asthma cases (mean (SD) = 7.6 (2.7)). In 2018 and 2019, respectively, mean weekly admissions were 9.2 (1.9) and 8.0 (2.0) paediatric asthma cases, while in 2020 the mean was 5.6 (2.7) cases. Significant differences in mean weekly paediatric asthma exacerbation admissions were detected by year, with mean weekly admissions for 2020 being significantly lower than that for 2018 and 2019. During the lockdown (22 March to 1 May 2020), mean weekly admissions (2.6 (1.4)) was significantly lower than that before the lockdown (8.6 (2.0)) and after the lockdown (5.2 (2.0)). For the lockdown weeks only, the mean admissions for the year 2020 was significantly lower than that for years 2019 and 2018. The stringency index negatively correlated with the number of weekly admissions. CONCLUSION: NPI measures in Jordan seem to have positively impacted paediatric asthma exacerbation admissions. Further studies are needed to draw public health policies and fine-tune environmental and community policies.

Predictive utility of prior positive urine culture of extended- spectrum ß -lactamase producing strains.

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.