Hyun Miri, Lee Ji Yeon, Lim Kyong Ree, Kim Hyun Ah
Department of Infectious Diseases, Keimyung University Dongsan Hospital, School of Medicine & Institute for Medical Science, Keimyung University, Keimyung University, 1035 Dalgubeol-daero, Dalseogu, Daegu, 42601, South Korea.
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdonggu, Seoul, 05278, South Korea.
Infect Dis Ther. 2024 Mar;13(3):581-595. doi: 10.1007/s40121-024-00940-3. Epub 2024 Mar 9.
This study compared the clinical characteristics and antimicrobial susceptibility of uncomplicated acute pyelonephritis (APN) caused by Escherichia coli and Klebsiella pneumoniae.
We retrospectively reviewed the medical records of patients with uncomplicated APNs caused by E. coli and K. pneumoniae admitted to Keimyung University Dongsan Hospital between February 2014 and December 2021.
We enrolled 497 patients (372 with E. coli infection, 125 with K. pneumoniae infection). Male, healthcare-associated infection, solid tumors, liver cirrhosis, chronic renal disease, solid organ transplantation, and antibiotic usage within the last 3 months were more strongly associated with K. pneumoniae uncomplicated APNs than with E. coli. Bacteremia and fever occurred more frequently in E. coli uncomplicated APNs. Antimicrobial resistance rates to piperacillin/tazobactam and carbapenem were higher in K. pneumoniae. Antimicrobial resistance rates to aztreonam and ciprofloxacin were lower in K. pneumoniae. Thirty-day mortality was more observed in K. pneumoniae group in univariate analysis, but this difference was not observed after adjustment. Male sex, ultimately fatal disease in McCabe, and prior antibiotic use within 3 months were more associated with K. pneumoniae.
Male, underlying diseases, and prior antibiotic use was more associated with K. pneumoniae. Further study will be needed that microbiome of each situation and the related with the distribution of the strains.
本研究比较了由大肠杆菌和肺炎克雷伯菌引起的非复杂性急性肾盂肾炎（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2021年12月期间入住庆熙大学东山医院的由大肠杆菌和肺炎克雷伯菌引起的非复杂性APN患者的病历。
我们纳入了497例患者（372例大肠杆菌感染，125例肺炎克雷伯菌感染）。男性、医疗保健相关感染、实体瘤、肝硬化、慢性肾病、实体器官移植以及过去3个月内使用抗生素与肺炎克雷伯菌引起的非复杂性APN的相关性比与大肠杆菌引起的更强。大肠杆菌引起的非复杂性APN中菌血症和发热更为常见。肺炎克雷伯菌对哌拉西林/他唑巴坦和碳青霉烯类的耐药率更高。肺炎克雷伯菌对氨曲南和环丙沙星的耐药率更低。单因素分析中肺炎克雷伯菌组30天死亡率更高，但调整后未观察到这种差异。男性、McCabe最终致命疾病以及3个月内既往使用抗生素与肺炎克雷伯菌的相关性更强。
男性、基础疾病和既往使用抗生素与肺炎克雷伯菌的相关性更强。需要进一步研究每种情况的微生物群以及与菌株分布的关系。
