Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction:
Cephalosporins are increasingly used to treat severe urinary tract infections (sUTI) due to rising resistance with other first-line agents. When switching from intravenous to oral cephalosporins there is limited outcome data to guide agent selection.
Research Question or Hypothesis:
Does treatment failure differ between cefdinir and cephalexin when used as step-down therapy from intravenous antibiotics in patients with sUTI (pyelonephritis or urosepsis)?
Study Design:
Quantitative, multicenter, retrospective study.
Methods:
Patients admitted to three hospitals for sUTI from 1/1/2019 to 12/31/2019 were assessed. Cases were identified using ICD-10 codes N10, N39.0, and A41.9. Patients who received intravenous antibiotics for >24 hours and completed treatment with cephalexin or cefdinir were included. Exclusion included <18 years, pregnancy, nephrolithiasis, neurogenic bladder, chronic catheter, nephrostomy, or ileostomy. Data extracted included demographics, antibiotics used, culture results, and Charlson Comorbidity Index. The primary composite outcome was death, rehospitalization for UTI in 30 days, unplanned clinic or emergency visit for UTI in 30 days, hospitalization for any reason in 90 days, or C. difficile infection. Events were censored after first occurrence. Secondary outcomes included each individual composite outcome element. Chi-square, Fisher’s exact, and t-tests were conducted using SPSS. Linear regression was conducted using Stata.
Results:
Overall, 210 patients qualified: 75 cefdinir and 135 cephalexin cases. Patients were similar in baseline characteristics although there was more pyelonephritis among the cephalexin group (30.2% vs 46.7%, P=0.024). Composite failure occurred in 8% of patients receiving cefdinir and 14.1% receiving cephalexin (P=0.193). Individual secondary outcomes did not differ except clinic or emergency visit for UTI was lower among patients receiving cefdinir than cephalexin (0% vs 7.2%; P=0.028). Regression revealed no significant variable associations with treatment failure, but cephalexin use was associated with clinic or emergency visit for UTI (r2=0.075).
Conclusion:
Treatment failure rates did not differ between cefdinir and cephalexin; however, patients receiving cephalexin had more unplanned clinic and emergency visits.
Presenting Author
Andrew Miesner PharmD, BCPSAuthors
Olena Andrushko PharmD
Drake University
Jonathan Hurdelbrink PhD
Drake University
Kelsie Ross PharmD
Drake University
Geoffrey Wall PharmD, FCCP, BCPS
Sarah Wall BS-Health Sciences Candidate
Drake University