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Int J Infect Dis. 2014 Jun;23:8-13. doi: 10.1016/j.ijid.2013.12.021. Epub 2014 Mar 19.

Factors associated with ciprofloxacin- and cefotaxime-resistant Escherichia coli in women with acute pyelonephritis in the emergency department.

Author information

1
Department of Infectious Disease, Chonnam National University Medical School, Gwangju, Republic of Korea.
2
Department of Internal Medicine, Kangwon National University School of Medicine, Chucheon, Republic of Korea.
3
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
4
Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
5
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
6
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
7
Department of Internal Medicine, Inje University Busan-Paik Hospital, Busan, Republic of Korea.
8
Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea.
9
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea.
10
Department of Internal Medicine, Inje University College of Medicine, Sanggye-Paik Hospital, Nowon-gu, Seoul 139-707, Republic of Korea. Electronic address: kimbn@paik.ac.kr.

Abstract

BACKGROUND:

High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN).

METHODS:

We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli. The study was conducted from April 16 to June 10, 2012.

RESULTS:

Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX.

CONCLUSIONS:

Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.

KEYWORDS:

Acute pyelonephritis; Cefotaxime; Ciprofloxacin; Resistance; UTI; Urinary tract infection

PMID:
24657271
DOI:
10.1016/j.ijid.2013.12.021
[Indexed for MEDLINE]
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