Category: Professional Posters
Purpose: The emergence of antimicrobial resistant strains has made the treatment of urinary tract infections (UTIs) more challenging. There is limited research to compare the effectiveness of ceftriaxone versus levofloxacin in treating UTIs. Fluoroquinolones (FQ) are often preferred for the empiric treatment of urinary tract infections; however, FQ resistance continues to increase. At our institution, resistance is relatively low with resistance rates of Escherichia coli to levofloxacin at 15% and to ceftriaxone at 3%. Despite the setting of low resistance rates, we hypothesized that ceftriaxone therapy would result in less clinical failure than levofloxacin therapy in hospitalized adults treated for UTIs.
Methods: The institutional review board approved this single center, retrospective cohort of adult patients over a 5 year span (1/1/2012 to 12/31/2017) with a primary or secondary ICD-10 diagnosis code for any UTI. Included patients required at least 48 continuous hours of levofloxacin or ceftriaxone and a positive urine culture. Patients with urologic hardware, recent urologic procedures, history of a multi-drug resistant organism, pregnant, or who received any other antibiotic in the initial 48 hours were excluded. Patients were analyzed from therapy initiation until therapy discontinuation or discharge.The primary endpoint was clinical failure defined as a composite of attributable mortality, in vitro resistance, and change of empiric antimicrobial class. All significant variables from bivariate analysis were included in a multivariate regression model completed in the backwards stepwise method to determine predictors of clinical failure.
Results: There were 138 levofloxacin and 187 ceftriaxone treated patients included. In the final multivariate model, ceftriaxone therapy was protective of clinical failure (OR 0.51; 95% CI 0.27 to 0.96, p0.04) when controlling for chronic kidney disease (CKD), history of UTIs, cirrhosis, and fever at therapy initiation.
Conclusion: Patients treated with ceftriaxone experienced significantly less clinical failure than patients treated with levofloxacin, despite a high baseline susceptibility to FQ agents. Hospitalized patients with UTIs can be effectively treated with ceftriaxone as empiric therapy. Choice of empiric antibiotic therapy should be based on local antibiogram data.