BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.
Administration, Intravenous ; Aged ; Anti-Bacterial Agents/administration & dosage/adverse effects/*therapeutic use ; Cefuroxime/administration & dosage/adverse effects/*therapeutic use ; Community-Acquired Infections/diagnosis/*drug therapy/microbiology/urine ; Databases, Factual ; *Drug Resistance, Bacterial ; Escherichia coli/*drug effects/isolation & purification ; Escherichia coli Infections/diagnosis/*drug therapy/microbiology/urine ; Female ; Hospitalization ; Humans ; Microbial Sensitivity Tests ; Middle Aged ; Pyelonephritis/diagnosis/*drug therapy/microbiology/urine ; Remission Induction ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Urinalysis ; Urinary Tract Infections/diagnosis/*drug therapy/microbiology/urine ; Urine/microbiology

No abstract available.
Abdominal Pain/etiology ; Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Escherichia coli/isolation & purification ; Escherichia coli Infections/*diagnosis/drug therapy/microbiology/urine ; Female ; Humans ; Kidney/*abnormalities/radiography ; Middle Aged ; Pyelonephritis/*diagnosis/drug therapy/microbiology/urine ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: We investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI). MATERIALS AND METHODS: We examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed. RESULTS: CRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN. CONCLUSION: We conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.
Acute Disease ; C-Reactive Protein/*analysis ; Case-Control Studies ; Fever/microbiology ; Humans ; Infant ; Male ; Potassium/*urine ; Predictive Value of Tests ; Prospective Studies ; Proteinuria/diagnosis ; Pyelonephritis/*diagnosis/radionuclide imaging ; Sensitivity and Specificity ; Sodium/*urine ; *Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections/drug therapy/microbiology/*radionuclide imaging