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Impact of Extended-Spectrum Beta-Lactamase on Acute Pyelonephritis Treated with Empirical Ceftriaxone.
MedLine Citation:
PMID:  23941639     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Ceftriaxone is frequently administered empirically for hospitalized patients with acute pyelonephritis (APN) due to prevalent quinolone resistance in our hospital; however, its use is inappropriate for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, an increasing problem. Methods: A retrospective, 1:2 matched cohort study was performed to evaluate the impact of ESBL on APN treated with empirical ceftriaxone. Each patient in ESBL group was matched with two patients in the non-ESBL group, using a 16-point scoring system, which included age, sex, bacteremia, simplified acute physiology score 2, Charlson comorbidity index and APN severity score. Results: From 2009 to 2011, among 1,322 community-onset cases of the E. coli bacteriuria with 212 (16%) ESBL producers, 261 patients with APN were treated empirically with ceftriaxone in a secondary care hospital. Among these 261 cases, twenty-six patients in the ESBL group and 52 matched patients in the non-ESBL group (1:2) were included. Mean time to defervescence was 4.6±2.2 days in the ESBL group and 2.6±1.3 days in the non-ESBL group (p<0.01). Rate of microbiological resolution within 5 days after antibiotic treatment was 77% (17/22) in the ESBL group and 100% (45/45) in the non-ESBL group (p=0.01). The duration of hospitalization was 13.3±8.2 days in the ESBL group and 7.3±3.5 days in the non-ESBL group (p<0.01). No patient died in either group. Conclusion: Empirical ceftriaxone therapy for APN caused by ESBL-producing E. coli is inappropriate, and consequently can delay recovery and result in longer hospitalization.
Authors:
Shinwon Lee; Do Young Song; Seung Hyun Cho; Ki Tae Kwon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-13
Journal Detail:
Title:  Microbial drug resistance (Larchmont, N.Y.)     Volume:  -     ISSN:  1931-8448     ISO Abbreviation:  Microb. Drug Resist.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9508567     Medline TA:  Microb Drug Resist     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Division of Infectious Diseases, Department of Internal Medicine, Daegu Fatima Hospital , Daegu, Republic of Korea.
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