Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea?

Bongyoung Kim; Jieun Kim; Seong-heon Wie; Sun Hee Park; Young Kyun Cho; Seung-Kwan Lim; Sang Yop Shin; Joon Sup Yum; Jin Seo Lee; Ki Tae Kweon; Hyuck Lee; Hee Jin Cheong; Dae Won Park; Seong Yeol Ryu; Moon-Hyun Chung; Hyunjoo Pai

doi:10.3947/ic.2012.44.4.269

Journal List > Infect Chemother > v.44(4) > 1035158

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Kim, Wie, Park, Cho, Lim, Shin, Yum, Lee, Kweon, Lee, Cheong, Park, Ryu, Chung, and Pai: Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea?

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(4): 269-274.

Published online: 31 August 2012

DOI: https://doi.org/10.3947/ic.2012.44.4.269

Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea?

Bongyoung Kim¹, Jieun Kim¹, Seong-heon Wie², Sun Hee Park², Young Kyun Cho³, Seung-Kwan Lim⁴, Sang Yop Shin⁵, Joon Sup Yum⁶, Jin Seo Lee⁷, Ki Tae Kweon⁸, Hyuck Lee⁹, Hee Jin Cheong¹⁰, Dae Won Park¹⁰, Seong Yeol Ryu¹¹, Moon-Hyun Chung¹², Hyunjoo Pai¹

¹Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea.

²Department of Internal Medicine, Catholic University, College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Gacheon University, College of Medicine, Gacheon, Korea.

⁴Department of Internal Medicine, Ajou University, College of Medicine, Suwon, Korea.

⁵Department of Internal Medicine, Jeju University, College of Medicine, Jeju, Korea.

⁶Department of Internal Medicine, Sungkyunkwan University, College of Medicine, Seoul, Korea.

⁷Department of Internal Medicine, Hallym University, College of Medicine, Seoul, Korea.

⁸Department of Infectious disease, Patima Hospital, Daegu, Korea.

⁹Department of Internal Medicine, Donga University, College of Medicine, Daegu, Korea.

¹⁰Department of Internal Medicine, Korea University, College of Medicine, Seoul, Korea.

¹¹Department of Internal Medicine, Gyemyeong University, College of Medicine, Daegu, Korea.

¹²Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea.

Correspondence to Hyunjoo Pai, M.D. Department of Internal Medicine, Hanyang Univ. College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-8356, Fax: +82-2-2298-9183, paihj@hanyang.ac.kr

Received 24 November 2011 Revised 6 April 2012 Accepted 9 April 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Uncomplicated acute cystitis (CA-UAC) is one of the most common infections treated with antibiotics in the community. However, few data on etiology of CA-UAC and its susceptibility to antibiotics are available, primarily because, in Korea, insurance does not allow reimbursement for microbiological evaluation of CA-UAC. However, microbiologic data on community-acquired uncomplicated acute pyelonephritis (CA-UAPN) are available. The objective of the study was to evaluate the question of whether microbiologic data on CA-UAPN can be used for treatment of CA-UAC; therefore, etiology and antimicrobial susceptibility were compared between pathogens of CA-UAC and those of CA-UAPN.

Materials and Methods

During 2008, 538 CA-UACs and 1,265 CA-UAPNs were recruited retrospectively from 14 hospitals (UTI research group). Microbiologic data on etiology and susceptibility to antibiotics were collected retrospectively.

Results

Urine culture was positive in 131 CA-UACs (131/469, 27.9%) and 719 CA-UAPNs (719/1249, 57.6%). Escherichia coli was the most common pathogen in both groups [83.2% (109/131) in CA-UAC vs. 91.9% (661/719) in CA-UAPN]. Susceptibility to common UTI regimens, such as ciprofloxacin, extended-spectrum cephalosporins, and trimethoprim/sulfamethoxazole did not differ between urinary pathogens of CA-UACs and CA-UAPNs, however, a significant difference was observed in rates of resistance to ampicillin/sulbactam (16.5% vs. 42.9%, P<0.001, respectively).

Conclusions

Rates of resistance of E. coli from CA-UAC and CA-UAPN to most antibiotics did not differ. For proper treatment, further microbiological evaluation for CA-UAC is mandatory.

Keywords: Cystitis, Pyelonephritis, Antibiotic, Resistance, Community

Figures and Tables

Figure 1

Co-resistance of E. coli from CA-UAC and CA-APN to several antibiotics (The size of the circle reflects the rate of resistance).

CA-UAC, Community-acquired uncomplicated acute cystitis; CA-UAPN, Community-acquired uncomplicated acute pyelonephritis SXT, Trimethoprim/sulfamethoxazole; CIP, Ciprofloxacin; ESBL, Extended-specturm beta-lactamase; R, Resistance

Table 1

Identified Pathogens of CA-UAC and CA-UAPN

CA-UAC, Community-acquired uncomplicated acute cystitis; CA-UAPN, Community-acquired uncomplicated acute pyelonephritis; No, Numbers.

Reproduced with permission from Shin J, Kim J, Wie SH, Cho YK, Lim SK, Shin SY, Yeom JS, Lee JS, Kweon KT, Lee H, Cheong HJ, Park SH, Park DW, Ryu SY, Chung MH, Yoo S, Pai H. Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact. Microb Drug Resist. 2012 Apr;18(2):169-75.

Table 2

Antibiotic Susceptibility of E. coli from CA-UAC and CA-UAPN

CA-UAC, Community-acquired uncomplicated acute cystitis; CA-UAPN, Community-acquired uncomplicated acute pyelonephritis; AMK, Amikacin; GEN, Gentamicin; TZP, Piperacillin/tazobactam; ESBL, Exteded-spectrum beta lactamase; FEP, Cepefime; CEF, Cephalothin; CIP, Ciprofloxacin; CRO, Ceftriaxone; CAZ, Ceftazidime; ATM, Aztreonam; TOB, Tobramycin; AMP, Ampicillin, SAM, Ampicillin/sulbactam; SXT, Trimethoprim/sulfamethoxazole.

^a; ESBL negative, ^b; ESBL positive

References

1. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies. Am J Med. 2002. 113:Suppl 1A. 35S–44S.

2. 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 America. European Society for Microbiology and Infectious Diseases. 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. 2011. 52:e103–e120.

3. The Korean Society of Infectious Diseases. The Korean Society for Chemotherapy. Korean Association of Urogenital Tract Infection and Inflammation. The Korean Society of Clinical Microbiology. Clinical guideline for the diagnosis and treatment of urinary tract infections: asymptomatic bacteriuria, uncomplicated & complicated urinary tract infections, bacterial prostatitis. Infect Chemother. 2011. 43:1–25.

4. Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. 1997. 11:551–581.

5. McNulty CA, Richards J, Livermore DM, Little P, Charlett A, Freeman E, Harvey I, Thomas M. Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care. J Antimicrob Chemother. 2006. 58:1000–1008.

6. Lee SS, Kim Y, Chung DR. Impact of discordant empirical therapy on outcome of community-acquired bacteremic acute pyelonephritis. J Infect. 2011. 62:159–164.

7. Hwang BY, Lee JG, Park DW, Lee YJ, Kim SB, Eom JS, Sohn JW, Cheong HJ, Kim WJ, Kim MJ, Park SC. Antimicrobial susceptibility of causative microorganisms in adults with acute pyelonephritis at one university-affiliated hospital in southwestern Seoul. Infect Chemother. 2003. 35:277–282.

8. Wie SH, Chang UI, Kim HW, Kim YS, Kim SY, Hur J, Kim SI, Kim YR, Kang MW. Clinical features and antimicrobial resistance among clinical isolates of women with community-acquired acute pyelonephritis in 2001-2006. Infect Chemother. 2007. 39:9–16.

9. Wie SH, Choi SM, Lee DG, Kim SY, Kim SI, Yoo JH, Shin WS, Kang MW. Antibiotic sensitivity of the causative organisms and use of antibiotics in women with community-acquired acute pyelonephritis. Korean J Infect Dis. 2002. 34:353–359.

10. Karlowsky JA, Hoban DJ, Decorby MR, Laing NM, Zhanel GG. Fluoroquinolone-resistant urinary isolates of Escherichia coli from outpatients are frequently multidrug resistant: results from the North American Urinary Tract Infection Collaborative Alliance-Quinolone Resistance study. Antimicrob Agents Chemother. 2006. 50:2251–2254.

11. Shin J, Kim J, Wie SH, Cho YK, Lim SK, Shin SY, Yeom JS, Lee JS, Kweon KT, Lee H, Cheong HJ, Park SH, Park DW, Ryu SY, Chung MH, Yoo S, Pai H. Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact. Microb Drug Resist. 2012. 18:169–175.

12. Kim ME, Ha US, Cho YH. Prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2006. Int J Antimicrob Agents. 2008. 31:Suppl 1. S15–S18.

13. Johnson DE, Lockatell CV, Russell RG, Hebel JR, Island MD, Stapleton A, Stamm WE, Warren JW. Comparison of Escherichia coli strains recovered from human cystitis and pyelonephritis infections in transurethrally challenged mice. Infect Immun. 1998. 66:3059–3065.

14. Johnson JR, Owens K, Gajewski A, Kuskowski MA. Bacterial characteristics in relation to clinical source of Escherichia coli isolates from women with acute cystitis or pyelonephritis and uninfected women. J Clin Microbiol. 2005. 43:6064–6072.

15. Johnson JR, Kuskowski MA, Gajewski A, Soto S, Horcajada JP, Jimenez de Anta MT, Vila J. Extended virulence genotypes and phylogenetic background of Escherichia coli isolates from patients with cystitis, pyelonephritis, or prostatitis. J Infect Dis. 2005. 191:46–50.

16. Kim KY, Kim CS, Lim DH. The ciprofloxacin resistance pattern of Escherichia coli isolated from female patients with community-acquired urinary tract infection in the Jeonnam and Gwangju region for the recent 2-years. Korean J Urol. 2008. 49:540–548.

17. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005. 18:657–686.

18. Lee SE, Choi H, Kim YK. A clinical study of oral fosfomycin (fosmycin) in the treatment of lower urinary tract infection. Korean J Urol. 1984. 25:167–172.

19. Ryu KH, Kim MK, Jeong YB. A recent study on the antimicrobial sensitivity of the organisms that cause urinary tract infection. Korean J Urol. 2007. 48:638–645.

20. Lee YW, Chang SK. Clinical efficacy of pivmecillinam (Selexid TM) in lower urinary tract infections. Korean J Urol. 1983. 24:413–417.

TOOLS

Similar articles