1308. Clinical Risk Factors for Early Clinical Failure of Therapy in Women with Community-Acquired Acute Pyelonephritis in Korea: A Multicenter Study
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • UTI poster.pdf (186.7 kB)
  • Background: Acute pyelonephritis (APN) is a common bacterial infection in the community and easily treated with antibiotics. However, if patients with APN do not show a clinical response after 72 hours of antibiotic treatment (early clinical failure), re-evaluation of the patients is usually required. The objectives of our study were to define the risk factors for early clinical failure of community-acquired APN (CA-APN) patients, and to verify whether early clinical failure gives an influence on mortality and final treatment outcome.

    Methods: We prospectively collected the clinical and microbiological data of women with CA-APN who visited 11 university hospitals in South Korea from March 2010 to February 2012. Clinical characteristics and treatment outcome were compared between the patients of early clinical failure and early clinical success groups.

    Results: During the study period, a total of 1,062 women with CA-APN were enrolled. The number of cases in the early clinical response group was 840 (79.1%) and that in the early clinical failure group was 222 (20.9%). In comparison of overall clinical outcome between two groups, the final clinical failure and mortality were higher in the early clinical failure group than in the early clinical success group (14.9% vs. 2.3%; P<0.001; 6.8% vs. 0.1%, P=0.001, respectively). In multiple logistic regression model for risk factors of early clinical failure, history of diabetes mellitus (DM) (P=0.024), chronic liver disease (P=0.002), malignancy (P=0.017), presence of azotemia (P=0.001), Pitt score≥1 (P=0.007), serum C-reactive protein level (CRP) ≥20 mg/dL (P=0.026) and white blood cell counts (WBC) ≥20,000/mm3 (P<0.001) were significantly associated. In subgroup analysis using the 743 patients with Enterobacteriaceae in urine culture to verify the effect of antibiotic resistance, fluoroquinolone resistance was independently associated with early clinical failure (P=0.033) in addition to the risk factors described above.

    Conclusion: Careful observation are necessary for women with CA-APN having one of the factors such as presence of DM, malignancy, chronic liver disease, azotemia, Pitt score≥1, WBC ≥20,000/mm3 and CRP ≥20 mg/dL.

    Seong-Heon Wie, MD, St. Vincent Hospital Catholic University, Suwon, South Korea, Moran Ki, MD, Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea, Jieun Kim, MD, Div. Infectious Diseases, Hanyang University Hospital, Seoul, South Korea, Yong Kyun Cho, M.D., Department of Infectious Disease, Gachon University Gil Hospital, Incheon, South Korea, Seung-Kwan Lim, MD, Internal Medicine, Ajou University Hospital, Incheon, South Korea, Jin Seo Lee, M.D., Department of Internal Medicine, division of infectious disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea, Ki Tae Kweon, MD, Patima Hospital, Daegu, South Korea, Hyuck Lee, MD, Dong-A University Hospital, Busan, Korea, Republic of, Hee Jin Cheong, MD, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea, Dae Won Park, MD, Korea Univ. Coll. of Med., Seoul, South Korea, Seong Yeol Ryu, M.D, Infectious Disease, Keimyung University Dongsan Medical Center, Daegu, South Korea, Moon-Hyun Chung, MD, Inha University Hospital, Incheon, South Korea and Hyunjoo Pai, MD, Div. Infectious Diseases, Dept. of Internal Medicine, Hanyang University Hospital, Seoul, South Korea

    Disclosures:

    S. H. Wie, None

    M. Ki, None

    J. Kim, None

    Y. K. Cho, None

    S. K. Lim, None

    J. S. Lee, None

    K. T. Kweon, None

    H. Lee, None

    H. J. Cheong, None

    D. W. Park, None

    S. Y. Ryu, None

    M. H. Chung, None

    H. Pai, None

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