Jang Young-Rock, Eom Joong Sik, Chung Wookyung, Cho Yong Kyun
Division of Infectious Disease.
Division of Nephrology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Medicine (Baltimore). 2019 Oct;98(43):e17720. doi: 10.1097/MD.0000000000017720.
The study aimed to determine the pattern of fever resolution among febrile patients undergoing treatment for acute pyelonephritis (APN) and prove that switching therapy based solely on persistent fever beyond 72 hours of antibiotics treatment may be unwarranted.For the purpose of this study, non-responders were defined as those patients who had a persistent fever over 72 hours after the initiation of antibiotic therapy. Responders were defined as those patients who became afebrile in less than 72 hours after the initiation of antibiotic therapy. Clinical cure was defined as the complete resolution of all symptoms during antibiotic therapy without recurrence during the follow-up period.A total of 843 female patients with uncomplicated community-acquired APN met all inclusion criteria. The non-responder group comprised of 248 patients (29%), and the remaining patients constituted the responder group. The median initial C-reactive protein level was higher (15.6 mg/dl vs 12.6 md/dl, P < .001) and bacteremia was more frequent (31% vs 40%, P = .001) in the non-responder group. Escherichia coli (E. coli) was the most common pathogen in both groups; there was no significant difference between the groups in the etiology of APN. Antimicrobial resistance and extended spectrum β-lactamase producing strains had an increasing trend in the non-responder group but there was no significant difference between the groups.This study shows that it is difficult to identify patients at risk of uncomplicated community-acquired APN by antibiotic-resistant pathogens based exclusively on persistent fever. Patients with a prolonged fever for more than 72 hours show similar antibiotic susceptibility patterns and are not associated with adverse treatment outcomes. Therefore, switching of current antibiotics to broad-spectrum antibiotics should be reserved in this patient population until antibiotic susceptibility test results are available.
该研究旨在确定接受急性肾盂肾炎（APN）治疗的发热患者的退热模式，并证明仅基于抗生素治疗72小时后仍持续发热而更换治疗方法可能是不必要的。在本研究中，无反应者定义为抗生素治疗开始后持续发热超过72小时的患者。有反应者定义为抗生素治疗开始后72小时内退热的患者。临床治愈定义为抗生素治疗期间所有症状完全消退且随访期间无复发。共有843例无并发症的社区获得性APN女性患者符合所有纳入标准。无反应者组包括248例患者（29%），其余患者构成有反应者组。无反应者组的初始C反应蛋白水平中位数较高（15.6mg/dl对12.6mg/dl，P<0.001），菌血症更常见（31%对40%，P=0.001）。大肠杆菌（E.coli）是两组中最常见的病原体；两组在APN病因方面无显著差异。无反应者组中耐药和产超广谱β-内酰胺酶菌株有增加趋势，但两组之间无显著差异。本研究表明，仅根据持续发热很难通过耐药病原体识别无并发症的社区获得性APN风险患者。发热持续超过72小时的患者表现出相似的抗生素敏感性模式，且与不良治疗结果无关。因此，在该患者群体中，在获得抗生素敏感性试验结果之前，应保留将当前抗生素换为广谱抗生素的做法。
