1441. Comparison of Cefpodoxime vs. Oral Cefuroxime for Urinary Tract Infections at a Large Academic Medical Center

Background Cefpodoxime (CPD) and cefuroxime (CFX) are both oral cephalosporins indicated for urinary tract infection (UTI) treatment. CPD may have unfavorable pharmacokinetics (PK) given the lesser degree of renal excretion and urine concentration vs. CFX and risk of collateral damage. The objective of this study was to compare the efficacy and safety of these two agents for UTI treatment. Methods We conducted a retrospective evaluation among adult patients who received CPD or oral CFX for ≥48 hours for UTI treatment between January 2013 and July 2018. The primary outcome was the rate of subsequent UTI within 90 days following therapy. Safety outcomes included the rate of Clostridium difficile infection (CDI) and development of isolates resistant to third-generation cephalosporins (TGC) within 90 days. We also examined missed opportunities for antibiotic de-escalation in culture-positive patients. Results Of 747 patients assessed for study inclusion, 295 patients met eligibility criteria (CPD n = 165, CFX n = 130). Median age was 72 years (IQR 55–84) and 71% were female. More patients in the CPD vs. CFX group had pyelonephritis (29% vs. 11%, P = 0.0005) and were treated in the emergency department (42% vs. 16%, P = 0.0005). Escherichia coli was most commonly isolated (n = 139), followed by Klebsiella spp. The rate of subsequent UTI for CPD vs. CFX was 18% vs. 16%, P = 0.647 at median of 25 vs. 32 days, P = 0.399. CDI rate was 1% vs. 2%, P = 0.324 and resistance to TGC was detected in 4% vs. 1%, P = 0.068 for CPD vs. CFX, respectively. Missed opportunities to de-escalate antibiotics based on cultures were found in one-third of patients. After adjusting for multiple factors in multivariate analysis, genitourinary abnormality (Odds Ratio [OR] 2.2, 95% CI 1.10–4.29, P = 0.026) and prior history of UTI within 180 days (OR 2.2, 95% CI 1.08–4.398, P = 0.03), but not the choice of oral cephalosporin, were the only independent predictors of subsequent UTI. Conclusion Despite less favorable urinary PK of CPD compared with CFX, in this patient cohort, no differences in efficacy or safety between the two agents for UTI treatment were found. These findings warrant further exploration. Stewardship strategies for de-escalation from higher generation cephalosporins to narrow-spectrum antibiotics based on susceptibilities should be implemented. Disclosures All authors: No reported disclosures.