title: Comparison of the effectiveness and antibiotic cost among ceftriaxone, ertapenem, and levofloxacin in treatment of community-acquired complicated urinary tract infections.
abstract: OBJECTIVE
  To study characteristics of patients with community-acquired complicated urinary tract infections (cUTIs) and to compare effectiveness and antibiotic cost of treatment with ceftriaxone (CRO), levofloxacin (LVX), and ertapenem (ETP).
  
  
  METHODS
  This retrospective study enrolled patients who had community-acquired cUTIs admitted to Division of Infectious Diseases in a single medical center from January 2011 to March 2013. Effectiveness, antibiotic cost, and clinical characteristics were compared among patients treated with CRO, LVX, and ETP.
  
  
  RESULTS
  There were 358 eligible cases, including 139 who received CRO, 128 treated with ETP, and 91 with LVX. The most common pathogen was Escherichia coli. The susceptibilities of these three agents were higher and more superior than first-line antibiotics. Treatment with ETP was associated with a significantly shorter time to defervescence since admission (CRO: 39 hours, ETP: 30 hours, and LVX: 38 h; p = 0.031) and shorter hospitalization stay (CRO: 4 days, ETP: 3 days, and LVX: 4 days; p < 0.001). However, the average antibiotic costs in the CRO group were significantly lower than that in the other two groups [CRO: 62.4 United States dollars (USD), ETP: 185.33 USD, and LVX: 204.85 USD; p < 0.001].
  
  
  CONCLUSIONS
  The resistance of cUTIs isolates to first-line antibiotic is high. Using ETP, CRO, and LVX in the treatment of cUTIs for good clinical response should be suggested. Among the three agents, ETP had better susceptibility than CRO and LVX, reached defervescence sooner, and was associated with shorter hospital stays. However, using CRO in cUTIs was less expensive than the other two agents.
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Songshan Branch of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Hsin-An
authors: HA
authors: Lin
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Ya-Sung
authors: YS
authors: Yang
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Jing-Xun
authors: JX
authors: Wang
authors: Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Hsin-Chung
authors: HC
authors: Lin
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: De-Yu
authors: DY
authors: Lin
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Chun-Hsiang
authors: CH
authors: Chiu
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Kuo-Ming
authors: KM
authors: Yeh
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: linjungchung1@yahoo.com.tw.
authors: Jung-Chung
authors: JC
authors: Lin
authors: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Feng-Yee
authors: FY
authors: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000191:economics; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000473:pathology; D003365:Costs and Cost Analysis; D000077727:Ertapenem; D004926:Escherichia coli; D005260:Female; D006801:Humans; D007902:Length of Stay; D064704:Levofloxacin / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage* / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D064704:Levofloxacin; D002443:Ceftriaxone; D000077727:Ertapenem
keywords: ceftriaxone; community-acquired urinary tract infection; cost effectiveness; ertapenem; levofloxacin