title: 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-β-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.
authors: Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: U-Im
authors: UI
authors: Chang
authors: Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Hyung Wook
authors: HW
authors: Kim
authors: Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea wiesh@chol.com.
authors: Seong-Heon
authors: SH
authors: Wie
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011704:Pyelonephritis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002439:Cefotaxime; D002444:Cefuroxime
references: Microb Drug Resist. 2013 Aug;19(4):316-22
references: 23473263
references: Clin Infect Dis. 2011 Mar 1;52(5):e103-20
references: 21292654
references: Int J Antimicrob Agents. 2011 Dec;38 Suppl:64-70
references: 22018988
references: Antimicrob Agents Chemother. 1976 Mar;9(3):511-9
references: 1259407
references: Arch Intern Med. 2003 May 26;163(10):1206-12
references: 12767958
references: Antimicrob Agents Chemother. 1977 Jul;12(1):47-50
references: 883818
references: Postgrad Med. 2010 Nov;122(6):7-15
references: 21084776
references: J Infect Chemother. 2009 Dec;15(6):390-5
references: 20012730
references: BJU Int. 2006 Jul;98(1):141-7
references: 16831159
references: Int J Antimicrob Agents. 2002 Feb;19(2):95-103
references: 11850161
references: Am Fam Physician. 2005 Mar 1;71(5):933-42
references: 15768623
references: Int J Clin Pract. 2014 Jun;68(6):749-55
references: 24447335
references: Infect Dis Clin North Am. 1997 Sep;11(3):583-92
references: 9378924
references: Clin Infect Dis. 2008 Mar 1;46(5):703-11
references: 18230045
references: Curr Infect Dis Rep. 2011 Dec;13(6):552-60
references: 21894469
references: Yonsei Med J. 2012 Jan;53(1):164-71
references: 22187248
references: Clin Microbiol Infect. 2014 Oct;20(10):O721-9
references: 24330047
references: Can J Infect Dis Med Microbiol. 2005 Nov;16(6):349-60
references: 18159518