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

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Republic of Korea
Pyelonephritis
Urinary Catheterization
Odds Ratio
Enterobacteriaceae
Confidence Intervals
Anti-Bacterial Agents
Logistic Models
Fosfomycin
Hospitalization
Clone Cells
Escherichia coli

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. / 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, Hee-Jin; Park, Dae Won; Ryu, S. Y.; Chung, M. H.; Ki, M.; Pai, H.

In: Infection, Vol. 41, No. 3, 01.06.2013, p. 603-612.

Research output: Contribution to journalArticle

Kim, B, Kim, J, Seo, MR, Wie, SH, Cho, YK, Lim, SK, Lee, JS, Kwon, KT, Lee, H, Cheong, H-J, Park, DW, Ryu, SY, Chung, MH, Ki, M & Pai, H 2013, 'Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea', Infection, vol. 41, no. 3, pp. 603-612. https://doi.org/10.1007/s15010-013-0441-z
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, Hee-Jin ; Park, Dae Won ; Ryu, S. Y. ; Chung, M. H. ; Ki, M. ; Pai, H. / Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. In: Infection. 2013 ; Vol. 41, No. 3. pp. 603-612.
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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.",
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AU - Kim, B.

AU - Kim, J.

AU - Seo, M. R.

AU - Wie, S. H.

AU - Cho, Y. K.

AU - Lim, S. K.

AU - Lee, J. S.

AU - Kwon, K. T.

AU - Lee, H.

AU - Cheong, Hee-Jin

AU - Park, Dae Won

AU - Ryu, S. Y.

AU - Chung, M. H.

AU - Ki, M.

AU - Pai, H.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - 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.

AB - 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.

KW - Community acquired

KW - Extended-spectrum β-lactamase

KW - Risk factor

KW - Urinary tract infection

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