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, H. J. Cheong, D. W. Park, S. Y. Ryu, M. H. Chung, M. Ki, H. Pai

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34 Citations (Scopus)

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

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