Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Setting
2.2. Patient Population
2.3. Microbiological Data and Definitions
2.4. Clinical Data and Definitions
2.5. Statistical Analyses
2.6. Ethical Statement
3. Results
3.1. Change in Causative Pathogens for CA-APN and Their Antibiotic Susceptibilities
3.2. Comparison of Demographic Data and Risk Factors
3.3. Comparison of Clinical Characteristics
3.4. Comparison of Clinical and Microbiological Characteristics after Propensity-Score Matching
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Pathogens | 2010–2011 | 2017–2018 | p |
---|---|---|---|
Escherichia coli | 526 (86.5) | 441 (87.3) | 0.680 |
Klebsiella pneumoniae | 24 (3.9) | 27 (5.3) | 0.270 |
Proteus spp. | 9 (1.5) | 7 (1.4) | 0.892 |
Enterobacter spp. | 5 (0.8) | 5 (1.0) | 0.763 |
Citrobacter spp. | 1 (0.1) | 5 (1.0) | 0.098 |
Subtotal | 565 (92.9) | 485 (96.0) | 0.025 |
Pseudomonas aeruginosa | 5 (0.8) | 5 (1.0) | 0.763 |
Acinetobacter baumannii | 2 (0.3) | 0 (0) | 0.504 |
Enterococcus spp. | 10 (1.6) | 4 (0.8) | 0.203 |
Staphylococcus aureus | 3 (0.5) | 0 (0) | 0.256 |
Others | 23 (3.8) | 11 (2.2) | 0.120 |
Total | 608 (100) | 505 (100) | - |
2010–2011 (n = 526) | 2017–2018 (n = 441) | ||||
---|---|---|---|---|---|
Antibiotics | Sensitive (%) | Resistant (%) | Sensitive (%) | Resistant (%) | p |
Amikacin (AMK) | 516 (98.1) | 10 (1.9) | 440 (99.8) | 1 (0.2) | 0.014 |
Amoxicillin/Clavulanate (AMC) | 307 (79.9) | 77 (20.1) | 267 (71.4) | 107 (28.6) | 0.006 |
Ampicillin (AMP) | 204 (39.8) | 308 (60.2) | 128 (29.0) | 313 (71.0) | <0.001 |
Ampicillin/Sulbactam (SAM) | 84 (53.2) | 74 (46.8) | 55 (40.7) | 80 (59.3) | 0.034 |
Aztreonam (ATM) | 430 (90.9) | 43 (9.1) | 304 (68.9) | 137 (31.1) | <0.001 |
Cefazolin (CFZ) | 232 (81.7) | 52 (18.3) | 237 (63.5) | 136 (36.5) | <0.001 |
Cefepime (FEP) | 474 (91.9) | 42 (8.1) | 301 (68.3) | 140 (31.7) | <0.001 |
Cefotaxime (CTX) | 472 (91.7) | 43 (8.3) | 292 (66.4) | 148 (33.6) | <0.001 |
Cefoxitin (FOX) | 363 (93.6) | 25 (6.4) | 409 (92.7) | 32 (7.3) | 0.644 |
Ceftazidime (CAZ) | 476 (91.4) | 45 (8.6) | 302 (68.5) | 139 (31.5) | <0.001 |
Fluoroquinolone (FQ) | 409 (73.6) | 113 (21.6) | 300 (68.0) | 141 (32.0) | <0.001 |
Gentamicin (GEN) | 404 (77.4) | 118 (22.6) | 296 (67.1) | 145 (32.9) | <0.001 |
Imipenem (IPM) | 521 (99.8) | 1 (0.2) | 441 (100) | 0 (0) | 1.000 |
Meropenem (MEM) | 395 (99.5) | 2 (0.5) | 135 (100) | 0 (0) | 1.000 |
Piperacillin (PIP) | 161 (40.1) | 240 (59.9) | 33 (32.7) | 68 (67.3) | 0.168 |
Piperacillin/Tazobactam (TZP) | 484 (95.5) | 23 (4.5) | 423 (95.9) | 18 (4.1) | 0.731 |
Trimethoprim/Sulfamethoxazole (SXT) | 291 (70.8) | 120 (29.2) | 235 (62.5) | 141 (37.5) | 0.013 |
Tobramycin (TOB) | 361 (76.5) | 111 (23.5) | 85 (63.4) | 49 (36.6) | 0.002 |
2010–2011 (n = 818) | 2017–2018 (n = 617) | p | |
---|---|---|---|
Demographic Data | |||
Age (years), mean ± SD | 56.66 ± 19.06 | 60.21 ± 18.73 | <0.001 |
Female sex (%) | 761 (93.0) | 566 (91.7) | 0.356 |
Underlying Comorbidities (%) | |||
Charlson’s comorbidity index, mean ± SD | 0.81 ± 1.37 | 1.04 ± 1.40 | 0.002 |
Diabetes mellitus | 216 (26.4) | 196 (31.8) | 0.026 |
Hemiplegia | 19 (2.3) | 10 (1.6) | 0.349 |
Cerebrovascular accident | 77 (9.4) | 58 (9.4) | 0.993 |
Congestive heart failure | 44 (5.4) | 19 (3.1) | 0.035 |
Connective tissue disease | 13 (1.6) | 24 (3.9) | 0.006 |
Malignancy | 32 (3.9) | 51 (8.3) | <0.001 |
Chronic pulmonary disease | 21 (2.6) | 23 (3.7) | 0.207 |
Liver disease | 26 (3.2) | 36 (5.8) | 0.014 |
Renal disease | 46 (5.6) | 49 (7.9) | 0.084 |
Dementia | 32 (3.9) | 38 (6.2) | 0.050 |
Pregnancy among female patients | 8 (1.0) | 4 (0.6) | 0.497 |
Menopause among female patients | 344/761 (45.2) | 319/566 (56.4) | <0.001 |
Bedridden state | 37 (4.5) | 28 (4.5) | 0.989 |
Underlying Urinary Tract Conditions (%) | |||
Indwelling urinary catheter | 12 (1.5) | 22 (3.6) | 0.010 |
Intermittent catheterization | 7 (0.9) | 2 (0.3) | 0.315 |
Benign prostatic hyperplasia among male patients | 12/57 (21.0) | 22/51 (43.1) | 0.011 |
Neurogenic bladder | 7 (0.9) | 25 (4.1) | <0.001 |
Urolithiasis | 15 (1.8) | 22 (3.6) | 0.040 |
Urinary retention | 4 (0.5) | 10 (1.6) | 0.031 |
Vesicoureteral reflux | 3 (0.4) | 1 (0.2) | 0.639 |
Vaginal wall prolapse among female patients | 3/761 (0.4) | 3/566 (0.5) | 0.705 |
Polycystic kidney | 6 (0.7) | 2 (0.3) | 0.478 |
Renal tumor | 1 (0.1) | 4 (0.6) | 0.172 |
Past History (%) | |||
History of admission during 1 year prior to inclusion | 188 (23.0) | 164 (26.6) | 0.117 |
History of antibiotic usage during 1 year prior to inclusion | 227 (27.8) | 191 (31.0) | 0.179 |
History of urinary tract infection | 209 (25.6) | 145 (23.5) | 0.373 |
Use of chemotherapeutic agents | 13 (1.6) | 10 (1.6) | 0.962 |
Use of immunosuppressants | 8 (1.0) | 10 (1.6) | 0.279 |
History of urinary catheterization during 1 month prior to inclusion | 13 (1.6) | 12 (1.9) | 0.685 |
History of urinary tract operation during 3 months prior to inclusion | 4 (0.5) | 2 (0.3) | 0.705 |
2010–2011 (n = 818) | 2017–2018 (n = 617) | p | |
---|---|---|---|
Clinical Features | |||
Pitt’s score, mean ± SD | 0.63 ± 1.07 | 0.69 ± 0.96 | 0.051 |
Urinary tract infection symptoms (%) | 526 (64.3) | 329 (53.3) | <0.001 |
Costovertebral angle tenderness (%) | 522 (63.8) | 409 (66.3) | 0.331 |
Back pain (%) | 260 (31.8) | 170 (27.6) | 0.083 |
Vomiting/diarrhea (%) | 224 (27.4) | 157 (25.4) | 0.410 |
Hematuria (%) | 436 (53.3) | 307 (49.8) | 0.183 |
Azotemia (%) | 135 (16.5) | 179 (29.0) | <0.001 |
Bacteremia (%) | 262 (32.0) | 269 (43.6) | <0.001 |
Antimicrobial Therapy | |||
Initial antimicrobial regimen | |||
Discordant to the antimicrobial susceptibility of causative organisms (%) | 67/597 (11.2) | 134/501 (26.8) | <0.001 |
ESC (%) | 406 (49.6) | 388 (62.9) | <0.001 |
FQ (%) | 211 (25.8) | 121 (19.6) | 0.006 |
BL/BLI (%) | 17 (2.1) | 58 (9.4) | <0.001 |
Carbapenem (%) | 13 (1.6) | 38 (6.1) | <0.001 |
Duration of antibiotic therapy, days | |||
Total antibiotics, mean ± SD | 16.55 ± 9.68 | 19.12 ± 9.90 | <0.001 |
Parenteral antibiotics, mean ± SD | 8.16 ± 6.44 | 10.17 ± 7.31 | <0.001 |
ESC, mean ± SD | 6.31 ± 8.13 | 7.82 ± 8.09 | 0.001 |
FQ, mean ± SD | 4.96 ± 8.64 | 6.61 ± 9.58 | 0.001 |
BL/BLI, mean ± SD | 0.94 ± 3.43 | 2.35 ± 5.13 | <0.001 |
Carbapenem | 0.59 ± 2.87 | 1.79 ± 4.89 | <0.001 |
Days of change of antibiotics, days, median (IQR) | 6 (4–8) | 6 (4–7) | 0.477 |
Outcomes | |||
Mortality (%) | 11/734 (1.9) | 2/597 (0.3) | 0.003 |
Clinical failure (%) | 39/734 (5.3) | 13/597 (2.2) | 0.003 |
Hospitalization days, median (IQR) | 7 (6–10) | 9 (7–13) | <0.001 |
Febrile days, median (IQR) | 2 (1–3) | 2 (1–4) | <0.001 |
2010–2011 (n = 617) | 2017–2018 (n = 617) | p | |
---|---|---|---|
Age (years), mean ± SD | 60.45 ± 18.62 | 60.22 ± 18.73 | 0.827 |
Charlson’s comorbidity index, mean ± SD | 0.97 ± 1.36 | 1.04 ± 1.40 | 0.398 |
Antibiotic Resistance Rate of Uropathogenic E. coli Isolates (%) | |||
Amikacin (AMK) | 6/400 (1.5) | 1/441 (0.2) | 0.058 |
Aztreonam (ATM) | 35/361 (9.7) | 137/441 (31.1) | <0.001 |
Cefazolin (CFZ) | 26/204 (12.7) | 136/373 (36.5) | <0.001 |
Cefepime (FEP) | 35/394 (8.9) | 140/441 (31.7) | <0.001 |
Cefotaxime (CTX) | 35/391 (9.0) | 148/440 (33.6) | <0.001 |
Cefoxitin (FOX) | 11/280 (3.9) | 32/441 (7.3) | 0.066 |
Fluoroquinolone (FQ) | 79/396 (19.9) | 141/441 (32.0) | <0.001 |
Gentamicin (GEN) | 88/398 (22.1) | 145/441 (32.9) | 0.001 |
Piperacillin/tazobactam (TZP) | 15/381 (3.9) | 18/441 (4.1) | 0.916 |
Trimethoprim/sulfamethoxazole (SXT) | 87/317 (27.4) | 141/376 (37.5) | 0.005 |
Discordance of initial antibiotic regimen to the antimicrobial susceptibility of causative organisms (%) | 61/461 (13.2) | 134/501 (26.8) | <0.001 |
Total duration of antibiotic therapy, days, mean ± SD | 16.94 ± 10.51 | 19.12 ± 9.90 | <0.001 |
Outcomes | |||
Mortality (%) | 11/549 (2.0) | 2/597 (0.3) | 0.008 |
Clinical failure (%) | 33/549 (6.0) | 13/597 (2.2) | 0.001 |
Hospitalization days, median (IQR) | 8 (6–11) | 9 (7–13) | <0.001 |
Febrile days, median (IQR) | 2 (1–3) | 2 (1–4) | 0.003 |
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Kwon, K.T.; Kim, B.; Ryu, S.-y.; Wie, S.-H.; Kim, J.; Jo, H.-u.; Park, S.Y.; Hong, K.-W.; Kim, H.I.; Kim, H.a.; et al. Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade. Antibiotics 2020, 9, 617. https://doi.org/10.3390/antibiotics9090617
Kwon KT, Kim B, Ryu S-y, Wie S-H, Kim J, Jo H-u, Park SY, Hong K-W, Kim HI, Kim Ha, et al. Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade. Antibiotics. 2020; 9(9):617. https://doi.org/10.3390/antibiotics9090617
Chicago/Turabian StyleKwon, Ki Tae, Bongyoung Kim, Seong-yeol Ryu, Seong-Heon Wie, Jieun Kim, Hyun-uk Jo, Se Yoon Park, Kyung-Wook Hong, Hye In Kim, Hyun ah Kim, and et al. 2020. "Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade" Antibiotics 9, no. 9: 617. https://doi.org/10.3390/antibiotics9090617