Abstract
This study examined changes in the clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between the period 2010–2011 and 2017–2018. We recruited all CA-APN patients aged ≥19 years who visited eight hospitals in South Korea from September 2017 to August 2018, prospectively. Data collected were compared with those from the previous study in 2010–2012, with the same design and participation from 11 hospitals. A total of 617 patients were enrolled and compared to 818 patients’ data collected in 2010–2011. Escherichia coli was the most common causative pathogen of CA-APN in both periods (87.3% vs. 86.5%, p = 0.680). E. coli isolates showed significantly higher antimicrobial resistance against fluoroquinolone (32.0% vs. 21.6%, p < 0.001), cefotaxime (33.6% vs. 8.3%, p < 0.001), and trimethoprim/sulfamethoxazole (37.5% vs. 29.2%, p = 0.013) in 2017–2018 than in 2010–2011. Total duration of antibiotic treatment increased from 16.55 ± 9.68 days in 2010–2011 to 19.12 ± 9.90 days in 2017–2018 (p < 0.001); the duration of carbapenem usage increased from 0.59 ± 2.87 days in 2010–2011 to 1.79 ± 4.89 days in 2010–2011 (p < 0.001). The median hospitalization was higher for patients in 2017–2018 than in 2010–2011 (9 vs. 7 days, p < 0.001). In conclusion, antimicrobial resistance of E. coli to almost all antibiotic classes, especially third generation cephalosporin, increased significantly in CA-APN in South Korea. Consequently, total duration of antibiotic treatment, including carbapenem usage, increased.
Highlights
Antimicrobial resistance is a global crisis for humans and threatens progress in health and achievement of the Sustainable Development Goals [1]
E. coli, which comprise more than 90% of cause of urinary tract infection (UTI), has become more resistant to multiple antibiotics commonly used for the treatment of Acute pyelonephritis (APN) in recent years [5]
A total of 617 patients with community-acquired acute pyelonephritis (CA-APN) were enrolled during this study period
Summary
Antimicrobial resistance is a global crisis for humans and threatens progress in health and achievement of the Sustainable Development Goals [1]. Once a pathogen acquires resistance, it affects negatively the prognosis of patients such as an increase in mortality, length of hospital stay, and medical costs [2]. It usually responds well to antimicrobial agents, increasing the proportion of antimicrobial-resistant pathogens makes its treatment challenging [4]. E. coli, which comprise more than 90% of cause of urinary tract infection (UTI), has become more resistant to multiple antibiotics commonly used for the treatment of APN in recent years [5]. As observed in other parts of the world, the increasing resistance of Enterobactericiales, including E. coli, against several antibiotics were observed in South Korea [6]. In discussing E. coli isolates from uncomplicated UTIs, the resistance rate against carbapenem still remains low, the increase in fluoroquinolone (FQ)-resistance was significant in the last decade [7,8]
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