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

  • Clinical and Epidemiological Study
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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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Acknowledgments

This work was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Internal Medicine, Hanyang University, College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, South Korea

    B. Kim, J. Kim, M.-R. Seo & H. Pai

  2. St. Vincent’s Hospital, Catholic University, Suwon, South Korea

    S.-H. Wie

  3. Gil Hospital, Gachon University, Incheon, South Korea

    Y. K. Cho

  4. Ajou University Hospital, Suwon, South Korea

    S.-K. Lim

  5. Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea

    J. S. Lee

  6. Daegu Fatima Hospital, Daegu, South Korea

    K. T. Kwon

  7. Dong-A University Hospital, Busan, South Korea

    H. Lee

  8. Korea University Guro Hospital, Seoul, South Korea

    H. J. Cheong

  9. Korea University Ansan Hospital, Ansan, South Korea

    D. W. Park

  10. Keimyung University Dongsan Hospital, Daegu, South Korea

    S. Y. Ryu

  11. Inha University Hospital, Incheon, South Korea

    M.-H. Chung

  12. Department of Preventive Medicine, Eulji University, College of Medicine, Daejeon, South Korea

    M. Ki

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  1. B. Kim
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  2. J. Kim
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  3. M.-R. Seo
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  4. S.-H. Wie
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  7. J. S. Lee
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  8. K. T. Kwon
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  9. H. Lee
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  13. M.-H. Chung
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  14. M. Ki
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  15. H. Pai
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Corresponding author

Correspondence to H. Pai.

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Kim, B., Kim, J., Seo, MR. et al. Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. Infection 41, 603–612 (2013). https://doi.org/10.1007/s15010-013-0441-z

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  • DOI: https://doi.org/10.1007/s15010-013-0441-z

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