title: Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea.
abstract: OBJECTIVE
  The aim of this study was to determine the risk factors and clinical characteristics of community-acquired acute pyelonephritis (CA-APN) caused by extended-spectrum β-lactamase (ESBL)-producing organisms.
  
  
  METHODS
  From March 2010 to February 2011, patients with CA-APN were recruited in 11 hospitals in South Korea. Clinical and microbiological data were collected prospectively, and the ESBLs and multilocus sequence types of the ESBL-producing Escherichia coli were characterized. Comparison between CA-APN caused by ESBL-producing Enterobacteriaceae and those by non-ESBL-producing organisms was performed.
  
  
  RESULTS
  A total of 566 patients were recruited. Enterobacteriaceae were detected in 526 patients. Forty-six isolates (46/526, 8.7 %) were positive for ESBLs. Clinical and microbiological failure did not differ between the two groups, despite there being fewer patients with ESBL-positive isolates provided with appropriate antibiotics initially (19.6 vs. 93.8 %, p < 0.001). However, the duration of hospitalization was longer in the ESBL group (10.5 vs. 7.0 days, p = 0.012). In a logistic regression model, Charlson score ≥1 point [odds ratio (OR) 3.4, 95 % confidence interval (CI) 1.6-7.0, p = 0.001], antibiotics usage during the previous year (OR 3.1, 95 % CI 1.4-7.2, p = 0.008), and urinary catheterization during the previous month (OR 4.4, 95 % CI 1.1-17.6, p = 0.035) were associated with the risks of CA-APN by ESBL producers. CTX-M-15 (48 %) and CTX-M-14 (38 %) were the most common ESBLs. ST131 was the most common clone (7/24, 29.1 %), which was more frequently resistant to cefepime, fosfomycin, and temocillin.
  
  
  CONCLUSIONS
  The risk factors for CA-APN by ESBL producers were Charlson score ≥1 point, antibiotics usage during the previous year, and urinary catheterization during the previous month.
authors.affiliation: Department of Internal Medicine, Hanyang University, College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, South Korea.
authors.forename: B
authors.initials: B
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: M-R
authors.initials: MR
authors.lastname: Seo
authors.forename: S-H
authors.initials: SH
authors.lastname: Wie
authors.forename: Y K
authors.initials: YK
authors.lastname: Cho
authors.forename: S-K
authors.initials: SK
authors.lastname: Lim
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.forename: K T
authors.initials: KT
authors.lastname: Kwon
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.forename: H J
authors.initials: HJ
authors.lastname: Cheong
authors.forename: D W
authors.initials: DW
authors.lastname: Park
authors.forename: S Y
authors.initials: SY
authors.lastname: Ryu
authors.forename: M-H
authors.initials: MH
authors.lastname: Chung
authors.forename: M
authors.initials: M
authors.lastname: Ki
authors.forename: H
authors.initials: H
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D011446:Prospective Studies; D011704:Pyelonephritis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases