Program Schedule

1043
Fluoroquinolone Resistance in Community-acquired Acute Pyelonephritis: Clinical Characteristics, Risk Factors and Clinical Response according to Fluoroquinolone MIC of Uropathogens

Session: Poster Abstract Session: UTIs: Management and Issues in DrugóResistance
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Objective of this study was to investigate clinical characteristics, risk factors of community-acquired acute pyelonephritis (CA-APN) caused by fluoroquinolone-resistant (FQ-R) uropathogen, and clinical response according to FQ MICs of uropathogen. 

Methods: We performed prospective observational study, which collected clinical data of CA-APN women with identified urinary pathogen from urine or blood cultures visiting 11 university hospital from March 2010 to February 2012.  

Results: Among 775 CA-APN patients, 587 with FQ susceptibility results were analyzed. Numbers of FQ-R and fluoroquinolone-susceptible (FQ-S) group were 127 (21.6%) and 460 (78.4%). In clinical characteristics, more patients in FQ-R group had an age >65 years (56.7% vs. 44.6%, p=0.015), history of antibiotics usage within 1 year (48.1% vs. 24.3%, p<0.001), history of admission within 1 year (43.7% vs. 22.8%, p<0.001), Charlson co-morbidity index >1 (26.8% vs. 21.3%, p=0.191), and extended-spectrum β-lactamase positivity (27.2% vs. 4.2%, p<0.001). Clinical response within 72 hours (early clinical response, ECR), final clinical response and mortality were not different between the two groups, although duration of hospitalization was longer in FQ-R group (median 9.0 vs. 7.0 days, p=0.001). In subgroup of 142 subjects using FQ during initial 72 hours, final clinical response or mortality was not different between the two groups. However, ECR was more frequent (50.0% vs. 75.0%, p=0.012) and duration of hospitalization was shorter (median 10.5 vs. 7.0 days, p<0.001) in FQ-S than FQ-R group. Multivariate logistic regression proved that age >65 years (OR 1.572, CI 1.004-2.460, p=0.048) and history of antibiotics usage within 1year (OR 2.902, CI 1.842-4.573, p<0.001) were significant risk factors for FQ-R. Among the 142 subjects, FQ MICs of Escherichia colifrom urine or blood were available in 64 patients, and ECR according to FQ MIC was analyzed: 72.5% (29/40) in patients with MIC <0.004~0.125µg/ml, 76.9% (10/12) with 0.19~3µg/ml, 80% (4/5) with 4~16µg/ml and 57.1% (4/7) with >32µg/ml. 

Conclusion: Risk factors of FQ-R were age >65 years and history of antibiotics usage within 1 year, and duration of hospitalization was longer in FQ-R than FQ-S group. Patients with FQ MIC ≤16µg/ml showed a similar ECR to those with susceptible isolates.

Yeonjae Kim, M.D., Infectious Disease, College of Medicine Hanyang University, seoul, South Korea, Seong-Heon Wie, MD, St. Vincent Hospital Catholic University, Suwon, South Korea, Jieun Kim, MD, Div. Infectious Diseases, Hanyang University Hospital, Seoul, South Korea, Moran Ki, MD, Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea, Yong Kyun Cho, M.D., Department of Infectious Disease, Gachon University Gil Hospital, Incheon, South Korea, Seoung-Kwan Lim, MD, Ajou University Hospital, Suwon, 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 Kwon, MD, PhD, Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea, Hyuck Lee, MD, Dong-A University Hospital, Busan, South Korea, Hee Jin Cheong, MD, Korea university College of Medicine, Seoul, South Korea, Seong Yeol Ryu, Gyemyeong University Hospital, 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:

Y. Kim, None

S. H. Wie, None

J. Kim, None

M. Ki, None

Y. K. Cho, None

S. K. Lim, None

J. S. Lee, None

K. T. Kwon, None

H. Lee, None

H. J. Cheong, None

S. Y. Ryu, None

M. H. Chung, None

H. Pai, None

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