Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
Antimicrob Agents Chemother. 2017 Nov 22;61(12). doi: 10.1128/AAC.01317-17. Print 2017 Dec.
The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years; < 0.001) and had higher rates of previous urinary tract infections (UTIs) (56.5% versus 24.5%; < 0.001) and previous antibiotic use (56.8% versus 22.8%; < 0.001). was more frequently isolated from patients with CA-APN than from patients with HCA-APN (79.9% versus 50.5%; < 0.001). The rates of resistance of strains from CA-APN patients versus HCA-APN patients were as follows: amoxicillin-clavulanic acid, 22.4% versus 53.2% ( = 0.001); cefuroxime, 7.7% versus 43.5% ( = 0.001); cefotaxime, 4.3% versus 32.6% ( < 0.001); ciprofloxacin, 22.8% versus 74.5% ( < 0.001); and co-trimoxazole, 34.5% versus 58.7% ( = 0.003). The site of acquisition, recurrent UTIs, and previous antibiotic use were independent risk factors for antimicrobial resistance. Relapse rates were significantly higher when definitive antimicrobial treatment was not adequate (37.1% versus 9.3% when definitive antimicrobial treatment was adequate; < 0.001). Our study reflects the rise of resistance to commonly used antibiotics in acute pyelonephritis. In order to choose the adequate empirical antibiotic therapy, risk factors for resistance should be considered.
本研究旨在比较社区获得性急性肾盂肾炎（CA-APN）和医疗保健相关性急性肾盂肾炎（HCA-APN），描述其结局，并确定可预测抗菌药物敏感性的变量。我们进行了一项观察性研究，纳入了 2014 年期间西班牙一家大学医院所有成年患者的急性肾盂肾炎（APN）连续发作。记录了每个发作的人口统计学数据、合并症、临床表现、微生物学数据、抗菌治疗和结局。采用多变量逻辑回归模型确定与抗菌药物耐药性相关的变量。共纳入 607 例患者，其中 503 例（82.9%）为 CA-APN，104 例（17.1%）为 HCA-APN。HCA-APN 患者比 CA-APN 患者年龄更大（70.4 岁 vs. 50.6 岁；<0.001），且既往尿路感染（UTI）发生率更高（56.5% vs. 24.5%；<0.001）和既往使用抗生素（56.8% vs. 22.8%；<0.001）。CA-APN 患者中分离的 菌株比 HCA-APN 患者更常见（79.9% vs. 50.5%；<0.001）。CA-APN 患者和 HCA-APN 患者的 菌株对抗菌药物的耐药率分别为：阿莫西林克拉维酸 22.4% vs. 53.2%（=0.001）；头孢呋辛 7.7% vs. 43.5%（=0.001）；头孢噻肟 4.3% vs. 32.6%（<0.001）；环丙沙星 22.8% vs. 74.5%（<0.001）；复方磺胺甲噁唑 34.5% vs. 58.7%（=0.003）。感染部位、复发性 UTI 和既往使用抗生素是抗菌药物耐药的独立危险因素。如果明确的抗菌治疗不充分，复发率显著更高（充分的明确抗菌治疗为 37.1%，而不充分的明确抗菌治疗为 9.3%；<0.001）。我们的研究反映了急性肾盂肾炎中常用抗生素耐药性的上升。为了选择合适的经验性抗生素治疗，应考虑耐药的危险因素。
