title: Risk factors for quinolone-resistance in women presenting with Escherichia coli acute pyelonephritis.
abstract: In France, according to the National Epidemiology Observatory of Bacterial Resistance to Antibiotics, 15.3% of outpatient urinary Escherichia coli isolates were fluoroquinolone-resistant in 2010. This puts to question the relevance of empirical fluoroquinolone therapy for community-acquired acute pyelonephritis (APN), potentially severe infections.
  
  
  OBJECTIVE
  We had for aim to identify individual risk factors for quinolone-resistant E. coli in community-acquired APN.
  
  
  METHODS
  A retrospective cohort study of 344 adult female patients presenting with E. coli APN was conducted at the Roanne and Saint-Etienne hospital emergency departments, from January 2011 to February 2012. We studied the demographic, administrative, and clinical factors. E. coli strains with intermediate susceptibility on the antibiogram were considered as resistant.
  
  
  RESULTS
  There was 23% of isolates that were resistant to nalidixic acid and 17.4% to ofloxacin. Complicated APN was not a significant risk factor (univariate analysis). Three risk factors of resistance to nalidixic acid and ofloxacin were independent (multivariate analysis): fluoroquinolone use in the previous 3 months, hospitalization in the previous 6 months, and stay in a long-term care facility. The resistance to ofloxacin reached 30.6% if at least 1 of these risk factors was present; it was 9% when none of the factors were present.
  
  
  CONCLUSIONS
  These results suggest that local recommendations for the empirical therapy of APN should be reviewed. The limitations of our study require backing up our results with prospective multicentric studies that could lead to drafting new national recommendations.
authors.affiliation: CHG de Saint-Chamond, 7, rue Emile Zola, 42400 Saint-Chamond, France. Electronic address: mag.roche@wanadoo.fr.
authors.forename: M
authors.initials: M
authors.lastname: Bedoin
authors.affiliation: Service de maladies infectieuses et tropicales du CHU de Saint-Etienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France. Electronic address: celine.cazorla@chu-st-etienne.fr.
authors.forename: C
authors.initials: C
authors.lastname: Cazorla
authors.affiliation: Service de maladies infectieuses et tropicales du CHU de Saint-Etienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France. Electronic address: frederic.lucht@chu-st-etienne.fr.
authors.forename: F
authors.initials: F
authors.lastname: Lucht
authors.affiliation: Unité d'hygiène inter-hospitalière du service de maladies infectieuses et tropicales au CHU de Saint-Etienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France. Electronic address: philippe.berthelot@chu-st-etienne.fr.
authors.forename: P
authors.initials: P
authors.lastname: Berthelot
authors.affiliation: Laboratoire de bactériologie du CHG de Roanne, 28, rue de Charlieu, 42328 Roanne, France.
authors.forename: M
authors.initials: M
authors.lastname: Boyer
authors.affiliation: Laboratoire de bactériologie du CHU de Saint-Etienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: A
authors.initials: A
authors.lastname: Carricajo
authors.affiliation: Service des urgences du CHG de Roanne, 28, rue de Charlieu, 42328 Roanne, France.
authors.forename: T
authors.initials: T
authors.lastname: Guérin
authors.affiliation: Service des urgences du CHU de Saint-Etienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: A
authors.initials: A
authors.lastname: Viallon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002391:Catchment Area, Health; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; 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 / Q000627:therapeutic use; D015242:Ofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D011704:Pyelonephritis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D009268:Nalidixic Acid; D015242:Ofloxacin
keywords: Escherichia coli; Facteurs de risque; Pyelonephritis; Pyélonéphrite; Quinolone-resistance; Risk factors; Résistance aux quinolones