The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli

  • Chang, U-Im (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung Wook (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Wie, Seong-Heon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2014.09.15
  • Accepted : 2014.11.07
  • Published : 2016.01.01
⟨ Previous Next ⟩

Abstract

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.

Keywords

Acknowledgement

Supported by : St. Vincent's Hospital, Research Institute of Medical Science

References

  1. O'Callaghan CH, Sykes RB, Griffiths A, Thornton JE. Cefuroxime, a new cephalosporin antibiotic: activity in vitro. Antimicrob Agents Chemother 1976;9:511-519. https://doi.org/10.1128/AAC.9.3.511
  2. Jones RN, Fuchs PC, Gavan TL, Gerlach EH, Barry AL, Thornsberry C. Cefuroxime, a new parenteral cephalosporin: collaborative in vitro susceptibility comparison with cephalothin against 5,887 clinical bacterial isolates. Antimicrob Agents Chemother 1977;12:47-50. https://doi.org/10.1128/AAC.12.1.47
  3. Roberts AP, Phillips R, Griffiths A, Sykes RB. The sensitivity of urinary isolates to cefuroxime, a new beta-lactamase stable cephalosporin. Curr Med Res Opin 1980;7:5-13. https://doi.org/10.1185/03007998009116508
  4. Gupta K, Hooton TM, Naber KG, et al. 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. https://doi.org/10.1093/cid/ciq257
  5. Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician 2005;71:933-942.
  6. Lim SK, Park IW, Lee WG, Kim HK, Choi YH. Change of antimicrobial susceptibility among Escherichia coli strains isolated from female patients with community-onset acute pyelonephritis. Yonsei Med J 2012;53:164-171. https://doi.org/10.3349/ymj.2012.53.1.164
  7. Wie SH, Kim HW, Chang UI. Use of gentamicin for women with community-acquired uncomplicated acute pyelonephritis caused by gentamicin-susceptible or -resistant Escherichia coli: 10-year experience. Microb Drug Resist 2013;19:316-322. https://doi.org/10.1089/mdr.2012.0140
  8. Naber KG, Savov O, Salmen HC. Piperacillin 2 g/tazobactam 0.5 g is as effective as imipenem 0.5 g/cilastatin 0.5 g for the treatment of acute uncomplicated pyelonephritis and complicated urinary tract infections. Int J Antimicrob Agents 2002;19:95-103. https://doi.org/10.1016/S0924-8579(01)00481-2
  9. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657-686. https://doi.org/10.1128/CMR.18.4.657-686.2005
  10. Jeon JH, Kim K, Han WD, et al. Empirical use of ciprofloxacin for acute uncomplicated pyelonephritis caused by Escherichia coli in communities where the prevalence of fluoroquinolone resistance is high. Antimicrob Agents Chemother 2012;56:3043-3046. https://doi.org/10.1128/AAC.06212-11
  11. Shin J, Kim J, Wie SH, et al. Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact. Microb Drug Resist 2012;18:169-175. https://doi.org/10.1089/mdr.2011.0139
  12. Ronald AR, Harding GK. Complicated urinary tract infections. Infect Dis Clin North Am 1997;11:583-592. https://doi.org/10.1016/S0891-5520(05)70374-3
  13. Safrin S, Siegel D, Black D. Pyelonephritis in adult women: inpatient versus outpatient therapy. Am J Med 1988;85:793-798. https://doi.org/10.1016/S0002-9343(88)80023-8
  14. Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing: 15th Informational Supplement CLSI Document M100-S15. Wayne: CLSI, 2005.
  15. Yu VL, Chiou CC, Feldman C, et al. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 2003;37:230-237. https://doi.org/10.1086/377534
  16. Pitout JD, Nordmann P, Laupland KB, Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56:52-59. https://doi.org/10.1093/jac/dki166
  17. Kang CI, Song JH, Chung DR, et al. Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents 2010;36:284-287. https://doi.org/10.1016/j.ijantimicag.2010.05.009
  18. Rodriguez-Bano J, Picon E, Gijon P, et al. Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis 2010;50:40-48. https://doi.org/10.1086/649537
  19. Calbo E, Romani V, Xercavins M, et al. Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006;57:780-783. https://doi.org/10.1093/jac/dkl035

Cited by

  1. UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies vol.8, pp.None, 2016, https://doi.org/10.3389/fmicb.2017.01566
  2. Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers vol.69, pp.3, 2016, https://doi.org/10.1099/jmm.0.001138
  3. Phage Therapy as a Novel Strategy in the Treatment of Urinary Tract Infections Caused by E. Coli vol.9, pp.6, 2020, https://doi.org/10.3390/antibiotics9060304