Risk factors that influence the empirical treatment of patients with acute pyelonephritis: a cohort study.
Antimicrob Agents Chemother. 2017 Oct 02;:
Authors: Bosch-Nicolau P, Falcó V, Viñado B, Andreu A, Len O, Almirante B, Pigrau C
Abstract
Objectives. The aim of the current study is to compare community-acquired acute pyelonephritis (CA-APN) with healthcare-associated acute pyelonephritis (HCA-APN), describe outcomes and identify variables that could predict antimicrobial susceptibility.Methods. 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, co-morbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define variables associated to antimicrobial resistance.Results. 607 patients were included in the study, 506 (83.4%) CA-APN and 101 (16.6%) HCA-APN. Patients with HCA-APN were older (70.4 vs. 50.6 y; p<0.001), had higher rates of previous urinary tract infections (UTI) (56.5% vs. 24.5%; p<0.001) and previous antibiotic use (56.8% vs. 22.8%; p<0.001). Escherichia coli was more frequently isolated in CA-APN than in HCA-APN (79.9% vs. 50.5%; p<0.001). Resistance rates of E. coli in CA-APN vs. HCA-APN were: amoxicillin-clavulanic acid (22.4% vs. 53.2%, p=0.001), cefuroxime (7.7% vs. 43.5%, p=0.001), ceftriaxone (4.3% vs. 32.6%, p<0.001), ciprofloxacin (22.8% vs. 74.5%, p<0.001), and cotrimoxazole (34.5% vs. 58.7%, p=0.003). Site of acquisition, recurrent UTI 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% vs. 9.3%; p<0.001).Conclusions. Our study reflects the rise of resistance to common used antibiotics in acute pyelonephritis. In order to choose the adequate empirical antibiotic therapy risk factors for resistance should be considered.
PMID: 28971876 [PubMed - as supplied by publisher]