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Fig. 1
Distribution of participating hospitals.
Fig. 2
Flow chart of inclusion of female patients with acute pyelonephritis.
Abstract
Background
Acute pyelonephritis (APN) is one of the most common bacterial infections. Because healthcare-associated (HCA) infections in the community setting have similar characteristics to hospital-acquired infections, HCA infections should be distinguished from community-acquired (CA) infections. However, the impact of HCA-APN on treatment outcomes has not been clearly defined. This study aimed to analyze the impact of HCA-APN on the appropriateness of empiric antibiotic therapy and outcomes in community-onset APN.
Methods
We prospectively identified women >18 years old who were hospitalized with APN via the emergency department and whose urine culture grew bacteria at 10 acute care hospitals in South Korea.
Results
Of the 388 APN episodes that were included, 99 (25.5%) were HCA-APN, and 289 (74.5%) were CA-APN. Compared with patients with CA-APN, patients with HCA-APN had comorbid conditions and septic shock more frequently. HCA-APN was caused by resistant uropathogens more often. Patients with HCA-APN had poorer outcomes (i.e., early/final clinical and microbiologic failures); however, this was not statistically significant. Patients with HCA-APN had significantly longer hospital stays than patients with CA-APN. In the multivariable logistic regression analysis for inappropriate empiric therapy, HCA-APN (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.07–3.57; P = .03) and being bed-ridden (OR, 3.04; 95% CI, 1.31–7.07; P = .01) were significant.
Conclusions
HCA-APN was associated with inappropriate empiric antibiotic therapy, which might lead to worse outcomes. These HCA factors should be considered when prescribing empiric antibiotic therapy in patients with community-onset APN.
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Sources of support: None.
