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

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 b-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 ESBLpositive 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 C1 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