Fosse Peter E, Brinkman Kevin M, Brink Hannah M, Conner Caroline E, Aden James K, Giancola Stephanie E
Department of Pharmacy, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, USA.
Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA.
Int J Antimicrob Agents. 2022 Apr;59(4):106560. doi: 10.1016/j.ijantimicag.2022.106560. Epub 2022 Mar 5.
Fluoroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) are first-line agents for acute pyelonephritis. Oral β-lactams are second-line agents owing to reported lower efficacy rates, primarily seen with aminopenicillins rather than cephalosporins. The increase in resistance rates and adverse effects associated with first-line agents provides justification to reconsider oral cephalosporins for pyelonephritis. Therefore, the objective of this study was to determine whether there is a difference in urinary tract infection (UTI) recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis. This was a retrospective, single-centre, observational cohort study from 1 December 2018 to 31 May 2020. The study population was adult TRICARE beneficiaries with a diagnosis of acute pyelonephritis who were treated with oral antibiotics. The two cohorts compared were first-line antibiotics (ciprofloxacin, levofloxacin and TMP-SMX) and oral cephalosporins. The primary outcome was UTI recurrence rate at 30 days, which was defined as a repeat clinic visit, emergency department visit or hospital admission for a UTI (cystitis or pyelonephritis). The secondary outcome was to determine independent risk factors for UTI recurrence. A total of 268 cephalosporin and 211 first-line cases were included. The primary composite outcome of UTI recurrence within 30 days occurred in 44 (16%) cephalosporin and 36 (17%) first-line cases (P = 0.851). Independent risk factors for UTI recurrence were chronic kidney disease and Klebsiella spp. isolation. In conclusion, there was no significant difference in UTI recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis in the outpatient setting.
氟喹诺酮类药物和甲氧苄啶/磺胺甲恶唑（TMP-SMX）是急性肾盂肾炎的一线治疗药物。口服β-内酰胺类药物是二线治疗药物，因为据报道其疗效较低，主要体现在氨基青霉素而非头孢菌素上。一线治疗药物的耐药率增加以及不良反应促使人们重新考虑将口服头孢菌素用于肾盂肾炎的治疗。因此，本研究的目的是确定在治疗急性肾盂肾炎时，口服头孢菌素与一线治疗药物在尿路感染（UTI）复发率上是否存在差异。这是一项回顾性、单中心、观察性队列研究，时间跨度为2018年12月1日至2020年5月31日。研究对象是诊断为急性肾盂肾炎并接受口服抗生素治疗的成年TRICARE受益人。比较的两个队列分别是一线抗生素（环丙沙星、左氧氟沙星和TMP-SMX）和口服头孢菌素。主要结局是30天时的UTI复发率，定义为因UTI（膀胱炎或肾盂肾炎）再次门诊就诊、急诊就诊或住院。次要结局是确定UTI复发的独立危险因素。共纳入268例头孢菌素治疗病例和211例一线治疗病例。30天内UTI复发的主要复合结局在44例（16%）头孢菌素治疗病例和36例（17%）一线治疗病例中出现（P = 0.851）。UTI复发的独立危险因素是慢性肾脏病和分离出克雷伯菌属。总之，在门诊环境中治疗急性肾盂肾炎时，口服头孢菌素与一线治疗药物在UTI复发率上无显著差异。
