title: Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact.
abstract: The objectives of this study were to investigate antibiotic resistance in urinary pathogens from Korean patients with uncomplicated acute pyelonephritis (UAPN), and to determine the effect of fluoroquinolone (FQ) resistance on clinical outcome in those patients with UAPN initially treated with FQ. Clinical and microbiologic data for all the APN patients attending 14 hospitals in South Korea in 2008 were collected retrospectively. Urinary pathogens were identified in 719 cases, and Escherichia coli was the most common pathogen (661/719, 91.9%). Antibiotic susceptibilities to several E. coli antibiotics were as follows: ciprofloxacin, 84.1%; trimethoprim-sulfamethoxazola (TMP-SMX), 67.2%; and extended-spectrum beta-lactamase-negative, 92.4%. FQ was the most frequent antibiotic prescribed for UAPN (45.3% intravenously and 53.9% by mouth). We compared clinical outcomes and hospital days in patients with FQ-resistant (32) and FQ-sensitive E. coli (173) who received FQ as initial empirical therapy. Clinical cure was higher in the FQ-sensitive group (78% vs. 91%, p=0.027), and hospital days were longer in the FQ-resistant group (9.6±5.5 days vs. 7±3.5 days, p=0.001). In conclusion, FQ-sensitivity of E. coli from UAPN was 84.1%. FQ treatment of UAPN caused by FQ-resistant E. coli has a lower cure rate and involves longer hospital stay than FQ treatment of cases caused by FQ-sensitive E. coli.
authors.affiliation: Department of Medicine, Rochester General Hospital , Rochester, New York, USA.
authors.forename: Jaehyun
authors.initials: J
authors.lastname: Shin
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.forename: Seong-Heon
authors.initials: SH
authors.lastname: Wie
authors.forename: Young Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Seung-Kwan
authors.initials: SK
authors.lastname: Lim
authors.forename: Sang Yop
authors.initials: SY
authors.lastname: Shin
authors.forename: Joon-Sup
authors.initials: JS
authors.lastname: Yeom
authors.forename: Jin Seo
authors.initials: JS
authors.lastname: Lee
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kweon
authors.forename: Hyuck
authors.initials: H
authors.lastname: Lee
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Cheong
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
authors.forename: Seong Yeol
authors.initials: SY
authors.lastname: Ryu
authors.forename: Moon-Hyun
authors.initials: MH
authors.lastname: Chung
authors.forename: Sunmi
authors.initials: S
authors.lastname: Yoo
authors.forename: Hyunjoo
authors.initials: H
authors.lastname: Pai
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011704:Pyelonephritis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin