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Clinical characteristics predicting early clinical failure after 72 h of antibiotic treatment in women with community-onset acute pyelonephritis: a prospective multicentre study

Title
Clinical characteristics predicting early clinical failure after 72 h of antibiotic treatment in women with community-onset acute pyelonephritis: a prospective multicentre study
Author
김지은
Keywords
acute pyelonephritis; early clinical failure; risk factor; URINARY-TRACT-INFECTIONS; ACUTE UNCOMPLICATED PYELONEPHRITIS; ESCHERICHIA-COLI; RISK-FACTORS; BACTEREMIA; MORTALITY; HOSPITALIZATION; ADULTS; IMPACT
Issue Date
2014-10
Publisher
WILEY-BLACKWELL, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA
Citation
CLINICAL MICROBIOLOGY AND INFECTION , Vol.20 No.10 [2014] , O721-O729
Abstract
In patients with community-onset acute pyelonephritis (CO-APN), assessing the risk factors for poor clinical response after 72h of antibiotic treatment (early clinical failure) is important. The objectives of this study were to define those risk factors, and to assess whether early clinical failure influences mortality and treatment outcomes. We prospectively collected the clinical and microbiological data of women with CO-APN in South Korea from March 2010 to February 2012. The numbers of cases in the early clinical success and early clinical failure groups were 840 (79.1%) and 222 (20.9%), respectively. Final clinical failure and mortality were higher in the early clinical failure group than in the early clinical success group (14.9% vs 2.3%, p<0.001; 6.8% vs 0.1%, p0.001, respectively). In a multiple logistic regression model, the risk factors for early clinical failure among the total 1062 patients were diabetes mellitus (OR 1.5; 95% CI 1.1-2.1), chronic liver diseases (OR 3.3; 95% CI 1.6-6.7), malignancy (OR 2.2; 95% CI 1.1-4.4), Pitt score 2 (OR 2.5; 95% CI 1.6-3.8), presence of azotaemia (OR 1.8; 95% CI 1.2-2.7), white blood cell count 20000/mm(3) (OR 2.5; 95% CI 1.6-4.0), serum C-reactive protein level 20mg/dL (OR 1.7; 95% CI 1.2-2.4), and history of antibiotic usage within the previous year (OR 1.5; 95% CI 1.1-2.2). Analysing the subgroup of 743 patients with CO-APN due to Enterobacteriaceae, fluoroquinolone resistance of the uropathogen was another factor associated with early clinical failure (OR 1.7; 95% CI 1.1-2.5). Simple variables of underlying diseases, previous antibiotic usage and initial laboratory test outcomes can be used to decide on the direction of treatment in CO-APN.
URI
http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65412-4/abstracthttp://hdl.handle.net/20.500.11754/51183
ISSN
1198-743X
DOI
10.1111/1469-0691.12500
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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