Treatment of Urinary Tract Infections in Hospitalized Adults Ceftriaxone Versus Levofloxacin

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.