A Study of Efficacy and Safety of Intravenous Cefiderocol (S-649266) Versus Imipenem/Cilastatin in Complicated Urinary Tract Infections
A Study of Efficacy and Safety of Intravenous Cefiderocol (S-649266) Versus Imipenem/Cilastatin in Complicated Urinary Tract Infections
The purpose of this study was to determine the efficacy and safety of intravenous cefiderocol
 (S-649266) in hospitalized adults with complicated urinary tract infections caused by
 Gram-negative pathogens.
Inclusion Criteria:

 -  Hospitalized male and female patients ≥ 18 years

 -  Clinical diagnosis of either complicated urinary tract infections (cUTI) with or
 without pyelonephritis or acute uncomplicated pyelonephritis

 -  cUTI diagnosed with a history of ≥ 1 of the following:

 -  Indwelling urinary catheter or recent instrumentation of the urinary tract

 -  Urinary retention (caused by benign prostatic hypertrophy)

 -  Urinary retention of at least 100 mL or more of residual urine after voiding
 (neurogenic bladder)

 -  Obstructive uropathy

 -  Azotemia caused by intrinsic renal disease (blood urea nitrogen and creatinine
 values greater than normal laboratory values) OR Pyelonephritis and normal
 urinary tract anatomy, ie, acute uncomplicated pyelonephritis AND

 At least 2 of the following signs or symptoms:

 -  Chills or rigors or warmth associated with fever (temperature greater than or equal to
 38 degrees Celsius)

 -  Flank pain (pyelonephritis) or suprapubic/pelvic pain (cUTI)

 -  Nausea or vomiting

 -  Dysuria, urinary frequency, or urinary urgency

 -  Costo-vertebral angle tenderness on physical examination AND

 All subjects had to have urinalysis evidence of pyuria demonstrated by 1 of the following:

 -  Dipstick analysis positive for leukocyte esterase

 -  ≥ 10 white blood cells (WBCs) per μL in unspun urine, or ≥ 10 WBCs per high power
 field in spun urine

 -  Positive urine culture within 48 hours prior to randomization containing ≥10^5
 colony forming unit (CFU)/mL of a Gram-negative uropathogen likely to be
 susceptible to imipenem (IPM)

 -  Patients who were treated previously with an empiric antibiotic other than the
 study drugs but failed treatment, both clinically and microbiologically, were
 eligible for the study if they had an identified Gram-negative uropathogen that
 was not susceptible to the previously used empiric treatment and likely to be
 susceptible to IPM

 -  Subjects receiving antibiotic prophylaxis for UTI who present with signs and
 symptoms consistent with an active new UTI

 Exclusion Criteria:

 -  Urine culture identifies only a Gram-positive pathogen and/or a Gram-negative
 uropathogen resistant to IPM

 -  Urine culture at study entry isolates more than 2 uropathogens or patient has a
 confirmed fungal UTI

 -  Asymptomatic bacteriuria, the presence of >10^5 CFU/mL of a uropathogen and pyuria but
 without local or systemic symptoms

 -  Patient is receiving hemodialysis or peritoneal dialysis