title: Health care-associated acute pyelonephritis is associated with inappropriate empiric antibiotic therapy in the ED.
abstract: BACKGROUND
  Acute pyelonephritis (APN) is one of the most common bacterial infections. Because health care-associated (HCA) infections in the community setting have similar characteristics to hospital-acquired infections, HCA infections should be distinguished from community-acquired (CA) infections. However, the impact of HCA-APN on treatment outcomes has not been clearly defined. This study aimed to analyze the impact of HCA-APN on the appropriateness of empiric antibiotic therapy and outcomes in community-onset APN.
  
  
  METHODS
  We prospectively identified women older than 18years who were hospitalized with APN via the emergency department and whose urine culture grew bacteria at 10 acute care hospitals in South Korea.
  
  
  RESULTS
  Of the 388 APN episodes that were included, 99 (25.5%) were HCA-APN and 289 (74.5%) were CA-APN. Compared with patients with CA-APN, patients with HCA-APN had comorbid conditions and septic shock more frequently. Health care-associated APN was caused by resistant uropathogens more often. Patients with HCA-APN had poorer outcomes (ie, early/final clinical and microbiologic failures); however, this was not statistically significant. Patients with HCA-APN had significantly longer hospital stays than did patients with CA-APN. In the multivariable logistic regression analysis for inappropriate empiric therapy, HCA-APN (odds ratio, 1.96; 95% confidence interval, 1.07-3.57; P=.03) and being bed-ridden (odds ratio, 3.04; 95% confidence interval, 1.31-7.07; P=.01) were significant.
  
  
  CONCLUSIONS
  Health care-associated APN was associated with inappropriate empiric antibiotic therapy, which might lead to worse outcomes. These HCA factors should be considered when prescribing empiric antibiotic therapy in patients with community-onset APN.
authors.affiliation: Department of Internal Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Yeon-Sook
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joon Sup
authors.initials: JS
authors.lastname: Yeom
authors.affiliation: Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Hee Kyoung
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Republic of Korea.
authors.forename: Yee Gyung
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: Jae-Bum
authors.initials: JB
authors.lastname: Jun
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Dankook University Medical College, Cheonan, Republic of Korea.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Rhee
authors.affiliation: Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, 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 / Q000009:adverse effects*; D003428:Cross Infection; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008508:Medication Errors; D011446:Prospective Studies; D011704:Pyelonephritis / Q000453:epidemiology / Q000209:etiology*; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents