Clinical Success Outcomes Research Articles

2821. A Comparison of Empirical Therapy with Cefazolin Versus Ceftriaxone for the Treatment of Complicated Urinary Tract Infections in a Tertiary Care VA Medical Center

Abstract Background Limited data exist regarding the utilization of a narrow-spectrum agent such as cefazolin for the treatment of complicated urinary tract infections (cUTIs). The objective of this study was to evaluate cefazolin compared with ceftriaxone for the empirical treatment of cUTIs in an inpatient setting. Methods We conducted a single center, retrospective cohort study of Veteran patients who received ≥24 hours of cefazolin or ceftriaxone for the empirical treatment of cUTIs between November 1, 2019 and September, 30 2022. The primary outcome was clinical success, defined as resolution of signs and symptoms of infection without re-initiation of antibiotics during hospitalization or relapse, at 30 days after cUTI diagnosis. Secondary outcomes included hospital length of stay and Clostridioides difficile infection (CDI) within 30 days of the end of antibiotic therapy. A multivariate logistic regression analysis was also conducted to identify independent factors associated with 30-day clinical success. Results We identified 118 patients (median age, 72 years; 97% men) with cUTI treated with cefazolin (n = 57) or ceftriaxone (n = 61) who met study criteria. Both study groups had similar demographics, although patients treated with ceftriaxone more frequently had subjective fever on admission or nephrolithiasis while cefazolin-treated patients had more urinary catheters or receipt of another antibiotic prior to study drug. Clinical success was achieved in 51 (90%) and 53 (87%) in the cefazolin and ceftriaxone groups, respectively (P = 0.66). Multivariate analysis identified patients with urinary catheters as an independent predictor of decreased clinical success, with an odds ratio at 30 days of 0.21 (95% CI, 0.06-0.75). Patients treated with cefazolin had a significantly longer length of hospital stay (median 0.4 days longer) compared with ceftriaxone-treated patients (P = 0.02). There were no patients in the cefazolin arm and 4 (7%) patients in the ceftriaxone arm who had CDI within 30 days (P = 0.12). Conclusion Cefazolin was similar to ceftriaxone for the treatment of cUTI based on the outcome of clinical success. Local susceptibility patterns to urinary pathogens should guide empiric treatment. Disclosures Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support

A pilot trial on lithium disilicate partial crowns using a novel prosthodontic functional index for teeth (FIT)

BackgroundLithium disilicate is now a well accepted material for indirect restorations. The aim of this trial was to evaluate two lithium disilicate systems using a novel prosthodontic Functional Index for Teeth (FIT).MethodsPartial adhesive crowns on natural abutment posterior teeth were made on sixty patients. Patients were divided into two groups: Group 1 IPS e.max press (Ivoclar-Vivadent, Schaan, Liecthestein), and Group 2 Initial LiSi press (GC Co., Tokyo, Japan). The restorations were followed-up for 3 years, and the FIT evaluation was performed at last recall. The FIT is composed of seven variables (Interproximal, Occlusion, Design, Mucosa, Bone, Biology and Margins), each of them are evaluated using a 0–1-2 scoring scheme, and is investigated by an oral radiograph and occlusal and buccal pictures. More in details, three variables have the three scores made on the presence or not of major, minor or no discrepancy (for ‘Interproximal’, ‘Occlusion’ and ‘Design’), presence or not of keratinized and attached gingiva (‘Mucosa’), presence of bone loss > 1.5 mm, < 1.5 mm or not detectable (‘Bone’), presence or not of Bleeding on Probing and or Plaque Index (‘Biology’), presence of detectable gap and marginal stain or not (‘Margins’). The Mann-Whitney ‘U’ test was used and the level of significance was set at p < 0.05. Also, “success” of the crowns (restoration in place without any biological or technical complication) and “survival” (restoration still in place with biological or technical complication) were evaluated.ResultsRegarding FIT scores, all partial crowns showed a stable level of the alveolar crest without detectable signs of bone loss in the radiographic analysis. All other evaluated parameters showed a high score, between 1.73 and 2. No statistically significant difference emerged between the two groups in any of the assessed variables (p > 0.05). All FIT scores were compatible with the outcome of clinical success and no one restoration was replaced or repaired and the success rate was 100%.ConclusionsThe results showed that it is possible to evaluate the clinical performance of partial crowns using FIT. The FIT proved to be an effective tool to monitor the performance of the restorations and their compatibility with periodontal tissues at the recall. The FIT can be really helpful for a standardized evaluation of the quality of the therapy in prosthodontic dentistry. The two lithium disilicate materials showed similar results after 3 years of clinical service.Trial registrationThe study protocol was approved by the Ethical Committee of University of Siena (clinicaltrial.gov # NCT 01835821), ‘retrospectively registered’.