title: Clinical implications of healthcare-associated infection in patients with community-onset acute pyelonephritis.
abstract: BACKGROUND
  Clinical and microbiological characteristics of healthcare-associated acute pyelonephritis (HCA-APN) have not been described in detail yet. We sought to delineate the differences between community-associated (CA)- and HCA-APN with specific interest in antibiotic resistance of causative microorganisms.
  
  
  METHODS
  We conducted a retrospective cohort study during a 1-y period at a large referral center. Patients who visited the emergency department with symptoms and signs of APN were included in the study population.
  
  
  RESULTS
  Among 319 cases with community-onset APN, 201 cases (63%) were classified as HCA-APN. Patients with HCA-APN had higher SOFA (sequential organ failure assessment) scores, longer length of hospital stay and a lower rate of complete response to antimicrobial therapy. Patients with complicated APN also had characteristics similar to those seen in HCA-APN. However, 14-day mortality rates were not different between CA-APN vs HCA-APN and between uncomplicated APN vs complicated APN. With regard to microbiological characteristics, Escherichia coli were less common in HCA-APN than in CA-APN (62.7% vs 93.2%, p < 0.001). Among E. coli isolates, quinolone resistance and extended-spectrum beta-lactamase (ESBL) production were more common in HCA-APN than in CA-APN (38.9% vs 12.7%, p < 0.001; 15.9% vs 0.8%, p < 0.001, respectively).
  
  
  CONCLUSIONS
  HCA-APN, and complicated APN, represents a distinct subset of urinary tract infections with more antibiotic-resistant pathogens and worse outcomes, which physicians should consider to provide optimal treatment.
authors: Division of Infectious Diseases, Samsung Medical Center, Seoul, Republic of Korea.
authors: Young Eun
authors: YE
authors: Ha
authors: Cheol-In
authors: CI
authors: Kang
authors: Eun-Jeong
authors: EJ
authors: Joo
authors: So Yeon
authors: SY
authors: Park
authors: Seung Ji
authors: SJ
authors: Kang
authors: Yu Mi
authors: YM
authors: Wi
authors: Doo Ryeon
authors: DR
authors: Chung
authors: Kyong Ran
authors: KR
authors: Peck
authors: Nam Yong
authors: NY
authors: Lee
authors: Jae-Hoon
authors: JH
authors: Song
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents