Predictors of uropathogens other than Escherichia coli in patients with community-onset acute pyelonephritis.
OBJECTIVE
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.
Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Y M
YM
Wi
S-W
SW
Kim
H-H
HH
Chang
S-I
SI
Jung
Y-S
YS
Kim
H S
HS
Cheong
H K
HK
Ki
J S
JS
Son
K T
KT
Kwon
S T
ST
Heo
J-S
JS
Yeom
K S
KS
Ko
C I
CI
Kang
D R
DR
Chung
K R
KR
Peck
J-H
JH
Song
D017714:Community-Acquired Infections; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data*; D011704:Pyelonephritis / Q000209:etiology*; D056910:Republic of Korea; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000209:etiology*