Predictors of uropathogens other than<i>Escherichia coli</i>in patients with community-onset acute pyelonephritis

Wi, Yu Mi; Kim, S.-W.; Chang, Hyun Ha; Jung, Seung Il; Kim, Y.-S.; Cheong, Hae Suk; Ki, Hyun Kyun; Son, Jun Seong; Kwon, Ki Tae; Heo, Sang Taek; Yeom, Joon‐Sup; Ko, Kwan Soo; Kang, Cheol In; Chung, Doo Ryeon; Peck, Kyong Ran; Song, Jae Hoon

doi:10.1111/ijcp.12368

Cited by 4 publications

(2 citation statements)

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“…Clinical symptoms, comorbid conditions, microbial pathogens, laboratory findings, and antimicrobial regimens were analyzed by reviewing the electronic medical records of women who were diagnosed with APN as a discharge diagnosis found in the hospital discharge database between January 2004 and December 2013. APN was defined by the presence of a fever (body temperature ≥ 38.0℃), pyuria on urinalysis (≥ 5 to 9 leukocytes/high power field), and bacteriuria with a colony count of ≥ 100,000 colony-forming units (CFU)/mL for clean voided urine [ 9 , 10 ]. Patients with the following conditions were excluded from the study: (1) a catheter-associated UTI; (2) an obstructive APN that demanded interventional managements, such as catheterization, percutaneous nephrostomy, or surgical treatment; or (3) APN occurring 48 hours or more after hospital admission.…”

Section: Methodsmentioning

confidence: 99%

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

Chang

Kim

Noh

et al. 2015

Korean J Intern Med

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Background/AimsAcute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN.MethodsWomen with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae.ResultsOf the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm3 in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393).ConclusionsElderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.

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Section: Methodsmentioning

confidence: 99%

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

Chang

Kim

Noh

et al. 2015

Korean J Intern Med

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“…Pyuria was defined as the presence of 5 to Ն9 leukocytes per high-power field of clean voided midstream urine. Bacteriuria was defined as the isolation of a single uropathogen (Ն10 5 CFU/ml of urine) (10,11). Patients were excluded if they had a urinary catheter-related infection or developed fever or urinary symptoms Ͼ48 h after hospital admission or needed a urological interventional procedure, such as catheterization, percutaneous drainage, or surgery to relieve the urinary obstruction.…”

Section: Methodsmentioning

confidence: 99%

Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

Chang

Kim

Wie

2015

Antimicrob Agents Chemother

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This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n ‫؍‬ 156) were compared with those of a cefotaxime-treated group (n ‫؍‬ 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P ‫؍‬ 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/ 89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P ‫؍‬ 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-␤-lactamase-producing Enterobacteriaceae, C-reactive protein levels of >15 mg/dl, and white blood cell counts of >15,000/mm 3 of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women. C ommunity-onset complicated acute pyelonephritis (APN) includes nonobstructive complicated APN and obstructive complicated APN, with the obstructive form requiring drainage and antimicrobial treatment. Extended-spectrum cephalosporin, penicillin with a ␤-lactamase inhibitor, an aminoglycoside, and a carbapenem are recommended as the initial antimicrobial agents for the treatment of complicated APN, which includes urosepsis, obstructive complicated APN, and health care-associated catheter-associated complicated APN (1-3).However, we hypothesized that more step-down antibiotics, such as cefuroxime, can effectively be used for the treatment of community-onset nonobstructive complicated APN, the patient population of which is more homogeneous and the uropathogens are more susceptible to cephalosporin treatment than those for the obstructive form (4, 5). The antimicrobial susceptibilities of uropathogens in community-onset nonobstructive complicated APN may be more similar to those in uncomplicated APN rather than those in health care-associated or catheter-associated urinary tract infections (UTIs).In the classification of UTIs and APNs, community-onset diabetic or elderly women with APN are usually included in the complicated APN subtype and may be treated initially with antimicrobial agents, which are recommended for compli...

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Nothing Is Simple in Acute Pyelonephritis: A Pragmatic, Semantic Nephrologist’s View

Piccoli

Ragni

2017

Imaging and Intervention in Urinary Tract Infections and Urosepsis

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Predictors of uropathogens other thanEscherichia coliin patients with community-onset acute pyelonephritis

Abstract: Community-onset APN caused by non-E. coli represents a distinct subset of urinary tract infections with worse outcomes. The defined risk factors related with non-E. coli should be taken into consideration when empirical antibiotic therapy is prescribed in patients with community-onset APN.

Cited by 4 publications

References 25 publications

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

Nothing Is Simple in Acute Pyelonephritis: A Pragmatic, Semantic Nephrologist’s View

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