title: Factors associated with ciprofloxacin- and cefotaxime-resistant Escherichia coli in women with acute pyelonephritis in the emergency department.
abstract: BACKGROUND
  High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN).
  
  
  METHODS
  We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli. The study was conducted from April 16 to June 10, 2012.
  
  
  RESULTS
  Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX.
  
  
  CONCLUSIONS
  Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.
authors.affiliation: Department of Infectious Disease, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kangwon National University School of Medicine, Chucheon, Republic of Korea.
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Hur
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University Busan-Paik Hospital, Busan, Republic of Korea.
authors.forename: Chisook
authors.initials: C
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea.
authors.forename: Chang-Seop
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Sanggye-Paik Hospital, Nowon-gu, Seoul 139-707, Republic of Korea. Electronic address: kimbn@paik.ac.kr.
authors.forename: Baek-Nam
authors.initials: BN
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004636:Emergency Service, Hospital; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011704:Pyelonephritis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D002439:Cefotaxime
keywords: Acute pyelonephritis; Cefotaxime; Ciprofloxacin; Resistance; UTI; Urinary tract infection