Predictors of uropathogens other than Escherichia coli in patients with community-onset acute pyelonephritis - Abstract

AIM: A constant reduction in the incidence of community-onset acute pyelonephritis (CO-APN) caused by Escherichia coli has been shown with a parallel increase incidence caused by other organisms.

Therefore, we evaluated the risk factors and outcome of non-E. coli as uropathogens in patients with community-onset APN.

METHODS: As a part of a nationwide multicentre surveillance study conducted in Korea, a total of 416 patients with CO-APN were collected with their epidemiological, antibiotic treatment and outcome data.

RESULTS: The risk factors and outcomes of non-E. coli as uropathogens were evaluated in a total of 416 patients with culture-confirmed CO-APN. Non-E. coli caused 127 cases (30.5%) of CO-APN. CO-APN caused by non-E. coli resulted in higher inappropriate empirical therapy (38.6% vs. 20.1%, p < 0.001), longer hospital stay (12.6 days vs. 6.7 days, p = 0.005) and higher 30-day mortality (9.4% vs. 3.8% p = 0.020) compared with CO-APN caused by E. coli. Multivariate analyses showed that male gender (OR, 3.48; CI, 2.13-5.67; p < 0.001), underlying haematological disease (OR, 5.32; CI, 1.17-24.254; p = 0.031), underlying benign prostate hyperplasia (OR, 2.61; CI, 1.02-6.74; p = 0.046), chronic indwelling urethral catheter (OR, 6.34; CI, 1.26-31.84; p = 0.025) and admission history in the previous 6 months (OR, 2.12; CI, 1.23-3.58; p = 0.005) were predictors for CO-APN caused by a non-E. coli isolate.

CONCLUSIONS: Community-onset APN caused by non-E. coli represents a distinct subset of urinary tract infections with worse outcomes. The defined risk factors related with non-E. coli should be taken into consideration when empirical antibiotic therapy is prescribed in patients with community-onset APN.

Written by:
Wi YM, Kim SW, Chang HH, Jung SI, Kim YS, Cheong HS, Ki HK, Son JS, Kwon KT, Heo ST, Yeom JS, Ko KS, Kang CI, Chung DR, Peck KR, Song JH.   Are you the author?
Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Reference: Int J Clin Pract. 2014 Jun;68(6):749-55.
doi: 10.1111/ijcp.12368

PubMed Abstract
PMID: 24447335 Infections Section