A Cohort Study of Risk Factors That Influence Empirical Treatment of Patients with Acute Pyelonephritis

作者：Bosch Nicolau Pau; Falco Vicenc; Vinado Belen; Andreu Antonia; Len Oscar; Almirante Benito; Pigrau Carles

来源：Antimicrobial Agents and Chemotherapy, 2017, 61(12): e01317-17.

DOI：10.1128/AAC.01317-17

<jats:title>ABSTRACT</jats:title>
<jats:p>
The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;
<jats:italic>P</jats:italic>
&lt; 0.001) and had higher rates of previous urinary tract infections (UTIs) (56.5% versus 24.5%;
<jats:italic>P</jats:italic>
&lt; 0.001) and previous antibiotic use (56.8% versus 22.8%;
<jats:italic>P</jats:italic>
&lt; 0.001).
<jats:named-content content-type="genus-species">Escherichia coli</jats:named-content>
was more frequently isolated from patients with CA-APN than from patients with HCA-APN (79.9% versus 50.5%;
<jats:italic>P</jats:italic>
&lt; 0.001). The rates of resistance of
<jats:named-content content-type="genus-species">Escherichia coli</jats:named-content>
strains from CA-APN patients versus HCA-APN patients were as follows: amoxicillin-clavulanic acid, 22.4% versus 53.2% (
<jats:italic>P</jats:italic>
= 0.001); cefuroxime, 7.7% versus 43.5% (
<jats:italic>P</jats:italic>
= 0.001); cefotaxime, 4.3% versus 32.6% (
<jats:italic>P</jats:italic>
&lt; 0.001); ciprofloxacin, 22.8% versus 74.5% (
<jats:italic>P</jats:italic>
&lt; 0.001); and co-trimoxazole, 34.5% versus 58.7% (
<jats:italic>P</jats:italic>
= 0.003). The site of acquisition, recurrent UTIs, and previous antibiotic use were independent risk factors for antimicrobial resistance. Relapse rates were significantly higher when definitive antimicrobial treatment was not adequate (37.1% versus 9.3% when definitive antimicrobial treatment was adequate;
<jats:italic>P</jats:italic>
&lt; 0.001). Our study reflects the rise of resistance to commonly used antibiotics in acute pyelonephritis. In order to choose the adequate empirical antibiotic therapy, risk factors for resistance should be considered.
</jats:p>

• 出版日期2017-12