A Comparison of the Therapeutic Efficacy of Cefuroxime versus 1 Cefotaxime as an Initial Antimicrobial Therapy for Community-2 Onset Complicated Non-Obstructive Acute Pyelonephritis due to 3 Enterobacteriaceae Infection in Women Using Propensity-4 Matched Analysis 5 6

24 25 This study was performed to compare the therapeutic efficacy of cefuroxime with that of 26 cefotaxime as initial antimicrobial therapies in women with complicated non-obstructive 27 acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical 28 characteristics and outcomes of a cefuroxime-treated group (n=156) were compared with 29 those of a cefotaxime-treated group (n=166). Of these 322 women, 90 from each group were 30 matched with propensity scores. The defervescence rates were not significantly different in 31 the cefuroxime and cefotaxime groups at 72 hours after the start of the antimicrobial therapies 32 (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the 33 follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not 34 significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) 35 versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), 36 respectively. The median hospital stay duration and the median times to defervescence in the 37 cefuroxime vs. cefotaxime groups were 8 (interquartile range [IQR], 7 to 10) versus 9 (IQR, 7 38 to 11) days and 55 (IQR, 37 to 70) versus 55 (IQR, 35 to 69) hours, respectively. Bacteremia, 39 extended-spectrum -lactamase producing Enterobacteriaceae, the C-reactive protein levels 40 that were ≥15 mg/dL, and the white blood cell counts that were ≥15,000/mm 3 of blood had 41 independent effects on the early clinical failure rates. Our data suggest that the effects of 42 cefuroxime are not different than those of cefotaxime when they are used as an initial 43 antimicrobial agent treatment for community-onset complicated non-obstructive APN in 44 women. 45

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