Abstract
Literature for the treatment of hospitalized patients with community-acquired urinary tract infections (UTI) is limited. Previous outpatient studies do not support the use of oral beta-lactams compared with oral fluoroquinolones (FQ) due to poor clinical cure rates. However, recent studies evaluating intravenous (IV) beta-lactams in more complicated cases demonstrate promising cure rates. In addition, the use of more narrow-spectrum beta-lactams may be preferable when possible, due to a lower incidence of “collateral damage” compared with FQ. This was a retrospective, non-inferiority, single-center, cohort study evaluating the effectiveness of IV cefazolin compared with FQ for the treatment of community-acquired UTI in an inpatient setting. The primary endpoint was clinical failure, defined as the presence of one or more signs or symptoms of UTI that required a change in antibiotics, re-initiation of antibiotics for UTI treatment during the hospital stay, and re-hospitalization with a UTI diagnosis within 30 days after discharge. The secondary endpoints were a microbiological cure, hospital length of stay, inpatient antibiotic duration of treatment, emergence of resistance, and Clostridium difficile infection within 30 days of the end of antibiotic therapy. Overall, 73 patients were treated with either cefazolin (n = 43) or FQ (n = 30) between April 2015 to January 2016. The clinical failure rates were 2% and 7% in the cefazolin and FQ groups, respectively (p = 0.56). Additionally, there were no significant differences between the secondary endpoints. Treatment with cefazolin, a more narrow-spectrum agent with a potential for less “collateral damage,” was non-inferior to FQ for community-acquired UTI in an inpatient setting.
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Acknowledgments
We acknowledge Stephanie Chiu, MPH for assistance with statistical analysis.
The contents of this publication were presented in a poster format at Eastern States Pharmacy Conference, Hershey, PA, USA, in May of 2016.
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This is a retrospective study that has been reviewed by the institutional review board prior (IRB) to the beginning of the study. A letter from the IRB has been attached in the supplementary section.
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Informed consent was not required for this study as it was a retrospective study and no interventions were taken that would impact patient care. In addition, informed consent was not required according to per institutional policies and no identifying details were revealed regarding patients.
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Uppala, A., King, E. & Patel, D. Cefazolin versus fluoroquinolones for the treatment of community-acquired urinary tract infections in hospitalized patients. Eur J Clin Microbiol Infect Dis 38, 1533–1538 (2019). https://doi.org/10.1007/s10096-019-03582-3
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DOI: https://doi.org/10.1007/s10096-019-03582-3