Hyun Miri, Lee Ji Yeon, Kim Hyun Ah, Ryu Seong Yeol
Department of Infectious Diseases, Keimyung University Dongsan Medical Center, Daegu, Korea.
Infect Chemother. 2019 Jun;51(2):130-141. doi: 10.3947/ic.2019.51.2.130.
and are two of the most common causes of urinary tract infection. The purpose of this study was to compare clinical characteristics and antimicrobial susceptibility of acute pyelonephritis (APN) between and K. pneumoniae.
We retrospectively reviewed medical records of patients with APN due to and K. pneumoniae between February 2014 and October 2017.
A total 329 patients were enrolled; 258 cases of and 71 cases of . Among them, 219 cases were categorized into community-onset APN; 194 cases of and 25 cases of , and 110 patients were categorized into healthcare-associated APN; 64 cases of and 46 cases of . Catheter-associated APN was more frequently observed in in both community-onset and healthcare-associated APN. Neurogenic bladder, obstructive uropathy, urinary tract stone, bacteremia, and severe APN were more related to in healthcare-associated APN. In multivariate analysis, urinary catheter was more associated with (odds ratio [OR] 9.643, 95% confidence intervals [CI] 4.919-18.904, = 0.001) and neurogenic bladder was more associated with (OR 3.765, 95% CI 1.112-12.772, = 0.033). Extended-spectrum β-lactamase (ESBL) production was observed in 29.0% of in community-onset APN. Among ESBL, antimicrobial susceptibility of piperacillin/tazobactam was significantly higher in and ciprofloxacin was significantly higher in .
were more associated with urinary catheter while tended to be more associated with urogenital problems. ESBL positivity showed no significance in healthcare-associated APN. In community-onset APN, ESBL producing was more observed than .
[细菌名称1]和肺炎克雷伯菌是尿路感染最常见的两种病因。本研究旨在比较[细菌名称1]和肺炎克雷伯菌所致急性肾盂肾炎（APN）的临床特征及抗菌药物敏感性。
我们回顾性分析了2014年2月至2017年10月期间因[细菌名称1]和肺炎克雷伯菌导致APN的患者的病历。
共纳入329例患者；其中[细菌名称1]感染258例，肺炎克雷伯菌感染71例。其中，219例被归类为社区获得性APN；[细菌名称1]感染194例，肺炎克雷伯菌感染25例，110例患者被归类为医疗保健相关APN；[细菌名称1]感染64例，肺炎克雷伯菌感染46例。在社区获得性和医疗保健相关APN中，导尿管相关APN在[细菌名称1]感染中更常见。在医疗保健相关APN中，神经源性膀胱、梗阻性尿路病、尿路结石、菌血症和重症APN与[细菌名称1]感染的相关性更强。多因素分析显示，导尿管与[细菌名称1]感染的相关性更强（比值比[OR]9.643，95%置信区间[CI]4.919 - 18.904，P = 0.001），神经源性膀胱与肺炎克雷伯菌感染的相关性更强（OR 3.765，95%CI 1.112 - 12.772，P = 0.033）。在社区获得性APN中，29.0%的[细菌名称1]产生超广谱β-内酰胺酶（ESBL）。在产ESBL菌中，哌拉西林/他唑巴坦对[细菌名称1]感染的抗菌敏感性显著更高，环丙沙星对肺炎克雷伯菌感染的抗菌敏感性显著更高。
[细菌名称1]感染与导尿管的相关性更强，而肺炎克雷伯菌感染往往与泌尿生殖系统问题的相关性更强。在医疗保健相关APN中，ESBL阳性无显著差异。在社区获得性APN中，产ESBL的[细菌名称1]感染比肺炎克雷伯菌感染更常见。
