Inappropriate empirical antibiotic therapy does not adversely affect the clinical outcomes of patients with acute pyelonephritis caused by extended-spectrum β-lactamase-producing Enterobacteriales
- 29 Downloads
Extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are often associated with inappropriate empirical therapy (IAT). The aim of this study was to investigate whether IAT of acute pyelonephritis (APN) caused by ESBL-PE is related to adverse outcomes. A retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Patients who had APN caused by ESBL-PE and were definitely treated with appropriate antibiotics for at least 7 days were enrolled. IAT was defined as when inappropriate empirical antibiotics were given 48 h or longer after initial diagnosis of APN. Primary endpoint was treatment failure defined as clinical and/or microbiologic failure. Secondary endpoints were length of hospital stay and recurrence of APN. Propensity score matching was used to adjust heterogeneity of each group. Among 175 eligible cases, 59 patients received IAT and 116 patients received appropriate empirical antimicrobial therapy (AT). Treatment failure was observed in five (8.4%) patients and nine (7.8%) patients in each group, respectively. After matching, the treatment failure rate was similar between both groups (adjusted odd ratio [aOR] 1.05; 95% confidence index [CI] 0.26–4.15). The length of hospital stay (median 11 days in the IAT group versus 11 days in the AT group; P = 0.717) and absence of recurrence within 2 months (90.3% in IAT and 86.7% in AT; P = 0.642) were also similar. IAT did not adversely affect the clinical outcome. In this regard, clinicians should be more cautious about indiscriminate prescription of broad-spectrum antibiotics such as carbapenem empirically for treatment of APN possibly caused by ESBL-PE.
KeywordsAcute pyelonephritis Extended-spectrum β-lactamase Empirical antimicrobial therapy Enterobacteriales
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
The study was approved by the local ethical research committee (IRB number: 2018–05-089).
- 2.Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C, Shin SY, Korean Network for Study of Infectious D (2010) Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents 36(3):284–287CrossRefGoogle Scholar
- 4.Lee CH, Chu FY, Hsieh CC, Hong MY, Chi CH, Ko WC, Lee CC (2017) A simple scoring algorithm predicting extended-spectrum beta-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia: matters of frequent emergency department users. Medicine (Baltimore) 96(16):e6648CrossRefGoogle Scholar
- 5.Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45(3):486–552CrossRefGoogle Scholar
- 7.Tumbarello M, Sanguinetti M, Montuori E, Trecarichi EM, Posteraro B, Fiori B, Citton R, D'Inzeo T, Fadda G, Cauda R, Spanu T (2007) Predictors of mortality in patients with bloodstream infections caused by extended-spectrum-beta-lactamase-producing Enterobacteriaceae: importance of inadequate initial antimicrobial treatment. Antimicrob Agents Chemother 51(6):1987–1994CrossRefGoogle Scholar
- 8.Tumbarello M, Sali M, Trecarichi EM, Leone F, Rossi M, Fiori B, De Pascale G, D'Inzeo T, Sanguinetti M, Fadda G, Cauda R, Spanu T (2008) Bloodstream infections caused by extended-spectrum-beta-lactamase- producing Escherichia coli: risk factors for inadequate initial antimicrobial therapy. Antimicrob Agents Chemother 52(9):3244–3252CrossRefGoogle Scholar
- 11.Frakking FN, Rottier WC, Dorigo-Zetsma JW, van Hattem JM, van Hees BC, Kluytmans JA, Lutgens SP, Prins JM, Thijsen SF, Verbon A, Vlaminckx BJ, Cohen Stuart JW, Leverstein-van Hall MA, Bonten MJ (2013) Appropriateness of empirical treatment and outcome in bacteremia caused by extended-spectrum-beta-lactamase-producing bacteria. Antimicrob Agents Chemother 57(7):3092–3099CrossRefGoogle Scholar
- 12.Joo EJ, Park DA, Lee NR, Moon SY, Choi JK, Ko JH, Peck KR (2017) Impact of appropriateness of empiric therapy on outcomes in community-onset bacteremia by extended-spectrum-beta-lactamase producing Escherichia coli and Klebisella pneumoniae definitively treated with carbapenems. Eur J Clin Microbiol Infect Dis 36(11):2093–2100CrossRefGoogle Scholar
- 13.Madhi F, Jung C, Timsit S, Levy C, Biscardi S, Lorrot M, Grimprel E, Hees L, Craiu I, Galerne A, Dubos F, Cixous E, Hentgen V, Bechet S, Urinary-tract Infection Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Children G, Bonacorsi S, Cohen R (2018) Febrile urinary-tract infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: a French prospective multicenter study. PLoS One 13(1):e0190910CrossRefGoogle Scholar
- 16.Kim S-H, Huh K, Cho SY, Kang C-I, Chung DR, Peck KR (2018) Factors associated with the recurrence of acute pyelonephritis caused by extended-Spectrum β-lactamase-producing Escherichia coli: the importance of infectious disease consultation. Diagn Microbiol Infect DisGoogle Scholar
- 20.U.S. Department of Health and Human Services Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf. Accessed 1 Nov 2018
- 21.Malaisri C, Phuphuakrat A, Wibulpolprasert A, Santanirand P, Kiertiburanakul S (2017) A randomized controlled trial of sitafloxacin vs. ertapenem as a switch therapy after treatment for acute pyelonephritis caused by extended-spectrum beta-lactamase-producing Escherichia coli: a pilot study. J Infect Chemother 23(8):556–562CrossRefGoogle Scholar
- 22.Chow S, Shao J, Wang H (2008) Sample size calculations in clinical research, 2nd edn, p 89Google Scholar
- 24.Goodman KE, Lessler J, Cosgrove SE, Harris AD, Lautenbach E, Han JH, Milstone AM, Massey CJ, Tamma PD, Antibacterial Resistance Leadership G (2016) A clinical decision tree to predict whether a bacteremic patient is infected with an extended-spectrum beta-lactamase-producing organism. Clin Infect Dis 63(7):896–903CrossRefGoogle Scholar
- 26.Jeon JH, Kim K, Han WD, Song SH, Park KU, Rhee JE, Song KH, Park WB, Kim ES, Park SW, Kim NJ, Oh MD, Kim HB (2012) Empirical use of ciprofloxacin for acute uncomplicated pyelonephritis caused by Escherichia coli in communities where the prevalence of fluoroquinolone resistance is high. Antimicrob Agents Chemother 56(6):3043–3046CrossRefGoogle Scholar
- 28.Greenhouse I, Babushkin F, Finn T, Shimoni Z, Aliman M, Ben-Ami R, Cohen R (2017) Long-term outcomes of inappropriate antibiotic therapy for upper urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: a retrospective cohort study. Diagn Microbiol Infect Dis 89(3):222–229CrossRefGoogle Scholar
- 29.Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE, Infectious Diseases Society of A, European Society for M, Infectious D (2011) 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(5):e103–e120CrossRefGoogle Scholar