Antibiotic resistance in adult female patients hospitalized for acute pyelonephritis: rates and predicting factors.
BACKGROUND
The empiric treatment of acute pyelonephritis (APN) with third generation cephalosporins (3GC) or fluoroquinolones (FQ) has been challenged by Escherichia coli resistance reported by community surveillance networks. But these could overestimate resistance because they do not discriminate between uncomplicated and complicated, or between community and care-related infections.


OBJECTIVE
We had for aim to: quantify resistance rates in hospitalized patients presenting with APN; identify subgroups with resistance <10% that could still be treated empirically with FQ or 3GC.


METHODS
We retrospectively analyzed files of patients presenting with documented APN, hospitalized in an Infectious Diseases Department from October 2010 to December 2012.


RESULTS
Hundred and fifty-six female patients (median age: 66, interquartile range: 37), were admitted for uncomplicated APN (36%) or APN (64%) at risk of complications by 1 (46%), 2 (40%), or 3 or more (14%) risk factors. Bacteremia was associated in 44% of uncomplicated and 8% of APN at risk of complications. E. coli was predominant (82%), resistant to 3GC in 6% of patients (including 4% ESBL) and to FQ in 15% of patients. The rate of resistance to FQ increased with the number of risk factors for complication, from 6% in uncomplicated APN, to 25% in patients with ≥3 risk factors. No enterobacteria was resistant to either 3GC or aminoglycosides.


CONCLUSIONS
The resistance rates of 3GC and aminoglycosides were <10% in patients hospitalized for APN. FQ resistance rates reached 15% but only 6% in uncomplicated APN. Hence, FQ empiric regimen should now be restricted to the treatment of uncomplicated APN without severe sepsis.
Infectiologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Groupe de recherche sur les antimicrobiens et les micro-organismes [GRAM, EA 2656], université de Rouen, IRIB, 22, boulevard Gambetta, 76000 Rouen, France. Electronic address: manuel.etienne@chu-rouen.fr.
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M
Etienne
Infectiologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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H
Van Elslande
Groupe de recherche sur les antimicrobiens et les micro-organismes [GRAM, EA 2656], université de Rouen, IRIB, 22, boulevard Gambetta, 76000 Rouen, France; Microbiologie, institut de biologie clinique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Choplin-Renard
Groupe de recherche sur les antimicrobiens et les micro-organismes [GRAM, EA 2656], université de Rouen, IRIB, 22, boulevard Gambetta, 76000 Rouen, France; Microbiologie, institut de biologie clinique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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M
Pestel-Caron
Infectiologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Groupe de recherche sur les antimicrobiens et les micro-organismes [GRAM, EA 2656], université de Rouen, IRIB, 22, boulevard Gambetta, 76000 Rouen, France.
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Caron
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000494:pharmacology* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002391:Catchment Area, Health; D002511:Cephalosporins / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008875:Middle Aged; D009268:Nalidixic Acid / Q000494:pharmacology; D015242:Ofloxacin / Q000494:pharmacology; D011704:Pyelonephritis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D009268:Nalidixic Acid; D015242:Ofloxacin
Antibiorésistance; Antibiotic resistance; Céphalosporines de troisième génération; Entérobactérie productrice de bêta-lactamase à spectre étendu; Extended spectrum beta-lactamase producing enterobacteria; Fluoroquinolones; Pyelonephritis; Pyélonéphrites; Third generation cephalosporins