Treatment of Urinary Tract Infections in Hospitalized Adults

Background The purpose of the study was to evaluate whether ceftriaxone therapy would result in less clinical failure than levofloxacin therapy in hospitalized adults treated for urinary tract infections (UTIs). Methods This was a single-center, retrospective cohort study of hospitalized adult patients with UTI as admitting diagnosis from 2012 to 2017. Patients were included in the study if they received ≥48 continuous hours of levofloxacin or ceftriaxone. The primary end point was clinical failure, defined as a composite of attributable mortality, in vitro resistance, or change of antimicrobial class. All variables from bivariate analysis with significance P < 0.20 were included in a multivariate regression model completed in the backward stepwise method to determine predictors of clinical failure. Results Of the 325 patients who met study inclusion criteria, 187 (57%) received ceftriaxone and 138 (43%) received levofloxacin. Clinical failure occurred in 11% of patients treated with ceftriaxone and 22% of patients treated with levofloxacin ( P < 0.01). Ceftriaxone therapy was associated with reduced odds of clinical failure when controlling for chronic kidney disease, history of UTIs, cirrhosis, and fever at therapy initiation. Conclusions Patients treated with ceftriaxone experienced significantly less clinical failure than patients treated with levofloxacin despite low baseline resistance rates.