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

B. Kim, J. Kim, M. R. Seo, S. H. Wie, Y. K. Cho, S. K. Lim, J. S. Lee, K. T. Kwon, H. Lee, Hee-Jin Cheong, Dae Won Park, S. Y. Ryu, M. H. Chung, M. Ki, H. Pai

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Abstract

Objectives: 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 β-lactamase (ESBL)-producing organisms. Methods: 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. Results: 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 ≥1 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. Conclusions: The risk factors for CA-APN by ESBL producers were Charlson score ≥1 point, antibiotics usage during the previous year, and urinary catheterization during the previous month.

Original languageEnglish
Pages (from-to)603-612
Number of pages10
JournalInfection
Volume41
Issue number3
DOIs
Publication statusPublished - 2013 Jun 1

Keywords

  • Community acquired
  • Extended-spectrum β-lactamase
  • Risk factor
  • Urinary tract infection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Kim, B., Kim, J., Seo, M. R., Wie, S. H., Cho, Y. K., Lim, S. K., Lee, J. S., Kwon, K. T., Lee, H., Cheong, H-J., Park, D. W., Ryu, S. Y., Chung, M. H., Ki, M., & Pai, H. (2013). Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. Infection, 41(3), 603-612. https://doi.org/10.1007/s15010-013-0441-z