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Abstract: PO0039

The Clinical Impact of Extended-Spectrum Beta-Lactamase-Producing Bacteria in Patients with Community-Acquired Acute Pyelonephritis in a Korean Hospital, 2010-2018

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Yoon, Se-Hee, Konyang University College of Medicine, Daejeon, Daejeon, Korea (the Republic of)
  • Hwang, Won Min, Konyang University College of Medicine, Daejeon, Daejeon, Korea (the Republic of)
  • Yun, Sung-Ro, Konyang University College of Medicine, Daejeon, Daejeon, Korea (the Republic of)
Background

Acute pyelonephritis (APN) is known to be the most complicated, severe urinary tract infection. It is not uncommon to experience the initial empirical antibiotic treatment failure of APN due to the increasing prevalence of ESBL producing bacteria. In this study, we investigated the microbial etiologies of acute pyelonephritis and resistance to antibiotics in APN.

Methods

We retrospectively reviewed microbial etiologies and resistance among patients who were admitted to Konyang University Hospital with APN from 2010 to 2018. Two blood cultures at different sites, and urine culture were performed at the time of admission. Statistical analysis was performed using R (version 4.0.0).

Results

The total number of patients with APN was 882, and Escherichia coli (57.3%) was the most common pathogen followed by Klebsiella spp. (2.8%), Enterococcus spp.(2%), Proteus spp. (0.9%), Enterobacter spp. (0.6%) and Pseudomonas aeruginosa (0.5%). The rate of ESBL producing bacteria has steadily increased over 9 years from 6.3% to 37.8%. Multivariate analysis showed that male sex (OR 2.395; 95% CI 1.201-4.776), APN occurence after 2015 (OR 1.170; 95% CI 1.057-1.296) and previous antibiotics exposure (OR 2.102; 95% CI 1.014-4.356) were risk factors for acquiring ESBL producing bacteria in urine or blood cultures. ESBL producing bacteria of blood or urine cultures in patients with APN was a significant prognostic factor for recurrence of APN within 1 year and mortality (HR 8.439; 95% CI 2.399-29.694).

Conclusion

Although quinolone and 3rd cephalosporin are recommended for empirical treatment of APN, there is a high risk of treatment failure due to the significant increase of ESBL producing bacteria in the community. Antibiotic therapy with APN should ideally be based on local patient characteristics and their antibiotic susceptibility profiles.