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Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea

Title
Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea
Author
김지은
Keywords
Extended-spectrum beta-lactamase; Urinary tract infection; Community acquired; Risk factor
Issue Date
2013-06
Publisher
Springer Science + Business Media
Citation
INFECTION, JUN 2013, 41(3), p603-p612
Abstract
The aim of this study was to determine the risk factors and clinical characteristics of community-acquired acute pyelonephritis (CA-APN) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms.From March 2010 to February 2011, patients with CA-APN were recruited in 11 hospitals in South Korea. Clinical and microbiological data were collected prospectively, and the ESBLs and multilocus sequence types of the ESBL-producing Escherichia coli were characterized. Comparison between CA-APN caused by ESBL-producing Enterobacteriaceae and those by non-ESBL-producing organisms was performed.A total of 566 patients were recruited. Enterobacteriaceae were detected in 526 patients. Forty-six isolates (46/526, 8.7 %) were positive for ESBLs. Clinical and microbiological failure did not differ between the two groups, despite there being fewer patients with ESBL-positive isolates provided with appropriate antibiotics initially (19.6 vs. 93.8 %, p < 0.001). However, the duration of hospitalization was longer in the ESBL group (10.5 vs. 7.0 days, p = 0.012). In a logistic regression model, Charlson score a parts per thousand yen1 point [odds ratio (OR) 3.4, 95 % confidence interval (CI) 1.6-7.0, p = 0.001], antibiotics usage during the previous year (OR 3.1, 95 % CI 1.4-7.2, p = 0.008), and urinary catheterization during the previous month (OR 4.4, 95 % CI 1.1-17.6, p = 0.035) were associated with the risks of CA-APN by ESBL producers. CTX-M-15 (48 %) and CTX-M-14 (38 %) were the most common ESBLs. ST131 was the most common clone (7/24, 29.1 %), which was more frequently resistant to cefepime, fosfomycin, and temocillin.The risk factors for CA-APN by ESBL producers were Charlson score a parts per thousand yen1 point, antibiotics usage during the previous year, and urinary catheterization during the previous month.
URI
https://link.springer.com/article/10.1007/s15010-013-0441-zhttp://hdl.handle.net/20.500.11754/46565
ISSN
0300-8126
DOI
10.1007/s15010-013-0441-z
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COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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