Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

Abstract

This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n ‫؍‬ 156) were compared with those of a cefotaxime-treated group (n ‫؍‬ 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P ‫؍‬ 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/ 89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P ‫؍‬ 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-␤-lactamase-producing Enterobacteriaceae, C-reactive protein levels of >15 mg/dl, and white blood cell counts of >15,000/mm 3 of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women. C ommunity-onset complicated acute pyelonephritis (APN) includes nonobstructive complicated APN and obstructive complicated APN, with the obstructive form requiring drainage and antimicrobial treatment. Extended-spectrum cephalosporin, penicillin with a ␤-lactamase inhibitor, an aminoglycoside, and a carbapenem are recommended as the initial antimicrobial agents for the treatment of complicated APN, which includes urosepsis, obstructive complicated APN, and health care-associated catheter-associated complicated APN (1-3).However, we hypothesized that more step-down antibiotics, such as cefuroxime, can effectively be used for the treatment of community-onset nonobstructive complicated APN, the patient population of which is more homogeneous and the uropathogens are more susceptible to cephalosporin treatment than those for the obstructive form (4, 5). The antimicrobial susceptibilities of uropathogens in community-onset nonobstructive complicated APN may be more similar to those in uncomplicated APN rather than those in health care-associated or catheter-associated urinary tract infections (UTIs).In the classification of UTIs and APNs, community-onset diabetic or elderly women with APN are usually included in the complicated APN subtype and may be treated initially with antimicrobial agents, which are recommended for compli...

Beneficial effects of early empirical administration of appropriate antimicrobials on survival and defervescence in adults with community-onset bacteremia

“…Hypothermia was defined as temporal body temperature of ≤ 36.0 °C. Defervescence was defined as an afebrile state in which tympanic body temperature maintained at < 37.0 °C for at least 24 h [12, 21], and the TtD as the period between the initiation of appropriate antimicrobial administration and the onset of defervescence. The bacteremia severity was graded, according to a Pitt bacteremia score using a previously validated scoring system based on vital signs, use of intravenous vasopressors, mental status, receipt of mechanical ventilation, and cardiac arrest during the first 24 h after ED arrival [12, 16].…”

Biofilm Formation in Klebsiella pneumoniae Bacteremia Strains Was Found to be Associated with CC23 and the Presence of wcaG

“…The susceptibilities of the isolates to clinically relevant antibiotics (amikacin, cefotaxime, ceftazidime, cefepime, cefoperazone-sulbactam, chloramphenicol, ciprofloxacin, levofloxacin, gentamicin, piperacillin-tazobactam, tetracycline, imipenem, and meropenem) and extended-spectrum β-lactamase (ESBL) production were detected with a Phoenix 100 automated microbiology system (BD) (Saffert et al, 2011 ) or by the disk diffusion test (Chang et al, 2015 ). The minimal inhibitory concentrations (MICs) of imipenem, meropenem, tigecycline, and eravacycline were determined by the agar dilution method according to Clinical and Laboratory Standards Institute guidelines (Michail et al, 2013 ).…”

A retrospective review of oral cephalosporins versus fluoroquinolones for the treatment of pyelonephritis

“…The use of intravenous cephalosporins for community-onset acute pyelonephritis as initial treatment followed by an appropriately targeted oral antibiotic such as a FQ or TMP-SMX for a total duration of 7-14 days has demonstrated high clinical cure rates of �95% in several studies [9][10][11]. As rates of resistance to both FQs and TMP-SMX continue to increase, oral β-lactams are often the only remaining therapeutic option for pyelonephritis which might avoid hospital admission and allow for outpatient treatment of an otherwise clinically stable patient.…”