Clinical Impact of Empiric Ceftriaxone for Hospitalized Patients with Community-Onset Healthcare-Associated UTIs

Background/Objectives: Ceftriaxone is widely used as empirical antimicrobial therapy (EAT) for urinary tract infections (UTIs). However, healthcare-associated urinary tract infections (HCA-UTIs) are often associated with inadequate EAT (IEAT). This study aims to evaluate the clinical impact of ceftriaxone as EAT in patients admitted to the hospital with community-onset HCA-UTIs in a setting with relatively high rates of antimicrobial resistance. Methods: A prospective observational study was conducted, comparing patients who received empirical treatment with ceftriaxone to those treated with other antibiotics. Results: A total of 235 cases were analyzed, 50.2% received ceftriaxone as EAT. The median age was 79 years, and 47.2% of patients were female. IEAT was significantly more frequent in the ceftriaxone group (36.4% vs. 17.1%, p = 0.001). Thirty-day mortality was 11.1%, with no significant difference between the ceftriaxone and non-ceftriaxone groups (11.9% vs. 10.3%, p = 0.752) but the use of antibiotics other than ceftriaxone was associated with a longer hospital stay (6 [4-8] vs. 5 [3-7] days, p = 0.037). The use of ceftriaxone as EAT was not associated with an increased risk of recurrence (16.1% vs. 15.4%, p = 0.709). Conclusions: In summary, empirical ceftriaxone use in patients with community-onset HCA-UTI was associated with a higher rate of inappropriate empirical therapy; however, it did not increase mortality or recurrence and was associated with a shorter hospital stay. These findings support the use of ceftriaxone as a potential option in selected patients without septic shock, while highlighting the importance of considering local resistance patterns and individual patient risk factors.