Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

Park,Seong-Ji; Jeong,In-Beom; Hwang,Won-Min; Yun,Sung-Ro; Yoon,Se-Hee

doi:10.3892/wasj.2021.113

Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

Authors:
- Seong-Ji Park
- In-Beom Jeong
- Won-Min Hwang
- Sung-Ro Yun
- Se-Hee Yoon
View Affiliations

Affiliations: Department of Internal Medicine, College of Medicine, Konyang University Myunggok Medical Research Institute, Daejeon 35365, Republic of Korea
Published online on: June 24, 2021 https://doi.org/10.3892/wasj.2021.113
Article Number: 42
Copyright: © Park et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study investigated the microbial etiologies and clinical impact of extended‑spectrum β‑lactamase (ESBL)‑producing bacteria according to urine and blood cultures from patients with acute pyelonephritis (APN). Data of all patients (age >15 years) who had been hospitalized at a single hospital with APN were collected between January, 2010 and December, 2018. Overall, 882 patients with APN were included. Patients were divided into an ESBL‑producing and non‑ESBL‑producing group. In addition, each group was further stratified in accordance with positive ESBL cultures from a urine sample (U‑ESBL group and U‑non‑ESBL group) or from either blood or urine samples (UB‑ESBL group and UB‑non‑ESBL group). In 651 (74%) of these cases, bacteria were isolated from either urine or blood samples. The prevalence of ESBL‑producing bacteria from either urine or blood samples (UB‑ESBL) was found to steadily increase over the 9‑year study period from 6.3 to 37.8%. The male sex [odds ratio (OR), 2.572; 95% confidence interval (CI), 1.295‑5.108] and previous antibiotic exposure (OR, 2.275; 95% CI, 1.105‑4.680) were significant risk factors for UB‑ESBL in the multivariable analysis. The patients in the UB‑ESBL group exhibited a significantly higher mortality rate (OR, 1.654; 95% CI, 1.106‑2.474) and a higher continuous renal replacement therapy (CRRT) rate. By multivariable analysis, UB‑ESBL and not U‑ESBL was an independent prognostic indicator for mortality and recurrence. Consequently, the use of carbapenems as a first‑line therapy for APN is expected to rapidly increase, and there is concern regarding the emergence of new antibiotic‑resistance bacteria. Global efforts to reduce resistance bacteria and the development of novel treatment methods other than the use of antibiotics to treat bacteria are urgently required. In addition, the results of the present study emphasize the importance of blood culture tests, as well as urine culture tests for the successful treatment of APN.

View Figures

View References

1	Najar MS, Saldanha CL and Banday KA: Approach to urinary tract infections. Indian J Nephrol. 19:129–139. 2009.PubMed/NCBI View Article : Google Scholar
2	Ki MR, Park TS, Choi BY and Foxman B: The epidemiology of acute pyelonephritis in South Korea, 1997-1999. Am J Epidemiol. 160:985–993. 2004.PubMed/NCBI View Article : Google Scholar
3	Johnson JR and Russo TA: Acute pyelonephritis in adults. N Engl J Med. 378:48–59. 2018.PubMed/NCBI View Article : Google Scholar
4	Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, et al: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases society of America and the European society for microbiology and infectious diseases. Clin Infect Dis. 52:e103–e120. 2011.PubMed/NCBI View Article : Google Scholar
5	Pietrucha-Dilanchian P and Hooton TM: Diagnosis, treatment, and prevention of urinary tract infection. Microbiol Spectr: doi: 10.1128/microbiolspec.UTI-0021-2015.
6	Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ and Stamm WE: Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious diseases society of America (IDSA) Clin Infect Dis. 29:745–758. 1999.PubMed/NCBI View Article : Google Scholar
7	Bosch-Nicolau P, Falcó V, Viñado B, Andreu A, Len O, Almirante B and Pigrau C: Risk factors that influence the empirical treatment of patients with acute pyelonephritis: A cohort study. Antimicrob Agents Chemother. 61:AAC.01317–17. 2017.PubMed/NCBI View Article : Google Scholar
8	Knaus WA, Draper EA, Wagner DP and Zimmerman JE: APACHE II: A severity of disease classification system. Crit Care Med. 13:818–829. 1985.PubMed/NCBI
9	Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW and Lente FV: Chronic Kidney Disease Epidemiology Collaboration: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 145:247–254. 2006.PubMed/NCBI View Article : Google Scholar
10	Clinical and Laboratory Standards Institute (CLSI): Performance standards for antimicrobial susceptibility testing; 17th informational supplement. Approved standard M100-S17. CLSI, Annapolis Junction, MD, 2007.
11	Park SH, Choi SM, Lee DG, Cho SY, Lee HJ, Choi JK, Choi JH and Yoo JH: Impact of extended-spectrum β-lactamase production on treatment outcomes of acute pyelonephritis caused by Escherichia coli in patients without health care-associated risk factors. Antimicrob Agents Chemother. 59:1962–1968. 2015.PubMed/NCBI View Article : Google Scholar
12	Tüzün T, Sayın Kutlu S, Kutlu M and Kaleli İ: Risk factors for community-onset urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli. Turk J Med Sci. 49:1206–1211. 2019.PubMed/NCBI View Article : Google Scholar
13	Albaramki JH, Abdelghani T, Dalaeen A, Khdair Ahmad F, Alassaf A, Odeh R and Akl K: Urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and antibiotic resistance. Pediatr Int. 61:1127–1132. 2019.PubMed/NCBI View Article : Google Scholar
14	Kim B, Kim J, Seo MR, Wie SH, Cho YK, Lim SK, Lee JS, Kwon KT, Lee H, Cheong HJ, et al: Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. Infection. 41:603–612. 2013.PubMed/NCBI View Article : Google Scholar
15	Díaz-Agero Pérez C, López-Fresneña N, Rincon Carlavilla AL, Hernandez Garcia M, Ruiz-Garbajosa P, Aranaz-Andrés JM, Maechler F, Gastmeier P, Bonten MJM and Canton R: Local prevalence of extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae intestinal carriers at admission and co-expression of ESBL and OXA-48 carbapenemase in Klebsiella pneumoniae: A prevalence survey in a Spanish university hospital. BMJ Open. 9(e024879)2019.PubMed/NCBI View Article : Google Scholar
16	Karanika S, Karantanos T, Arvanitis M, Grigoras C and Mylonakis E: Fecal colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae and risk factors among healthy individuals: A systemic review and metaanalysis. Clin Infect Dis. 63:310–318. 2016.PubMed/NCBI View Article : Google Scholar
17	Kim YJ, Lee JM, Cho J and Lee JH: Change in the annual antibiotic susceptibility of Escherichia coli in community-onset urinary tract infection between 2008 and 2017 in a tertiary care hospital in Korea. J Korean Med Sci. 34(e228)2019.PubMed/NCBI View Article : Google Scholar
18	Kang CI, Kim J, Park DW, Kim BN, Ha US, Lee SJ, Yeo JK, Min SK, Lee H and Wie SH: Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. Infect Chemother. 50:67–100. 2018.PubMed/NCBI View Article : Google Scholar
19	Luvsansharav UO, Hirai I, Nakata A, Imura K, Yamauchi K, Niki M, Komalamisra C, Kusolsuk T and Yamamoto Y: Prevalence of and risk factors associated with faecal carriage of CTX-M β-lactamase-producing enterobacteriaceae in rural Thai communities. J Antimicrob Chemother. 67:1769–1774. 2012.PubMed/NCBI View Article : Google Scholar
20	Schwaber MJ and Carmeli Y: Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in enterobacteriaceae bacteraemia: A systematic review and meta-analysis. J Antimicrob Chemother. 60:913–920. 2007.PubMed/NCBI View Article : Google Scholar
21	Marchaim D, Gottesman T, Schwartz O, Korem M, Maor Y, Rahav G, Karplus R, Lazarovitch T, Braun E, Sprecher H, et al: National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by enterobacteriaceae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 54:5099–5104. 2010.PubMed/NCBI View Article : Google Scholar
22	Freeman JT, McBride SJ, Nisbet MS, Gamble GD, Williamson DA, Taylor SL and Holland DJ: Bloodstream infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary care hospital in New Zealand: Risk factors and outcomes. Int J Infect Dis. 16:e371–e374. 2012.PubMed/NCBI View Article : Google Scholar
23	Qureshi ZA, Paterson DL, Peleg AY, Adams-Haduch JM, Shutt KA, Pakstis DL, Sordillo E, Polsky B, Sandkovsky G, Bhussar MK and Doi Y: Clinical characteristics of bacteraemia caused by extended-spectrum β-lactamase-producing enterobacteriaceae in the era of CTX-M-type and KPC-type β-lactamases. Clin Microbiol Infect. 18:887–893. 2012.PubMed/NCBI View Article : Google Scholar
24	Lee NY, Lee CC, Huang WH, Tsui KC, Hsueh PR and Ko WC: Carbapenem therapy for bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli or Klebsiella pneumoniae: Implications of ertapenem susceptibility. Antimicrob Agents Chemother. 56:2888–2893. 2012.PubMed/NCBI View Article : Google Scholar
25	Velasco M, Martínez JA, Moreno-Martínez A, Horcajada JP, Ruiz J, Barranco M, Almela M, Vila J and Mensa J: Blood cultures for women with uncomplicated acute pyelonephritis: Are they necessary? Clin Infect Dis. 37:1127–1130. 2003.PubMed/NCBI View Article : Google Scholar