Causative Organisms and Antibiotics Sensitivity in Community Acquired Acute Pyelonephritis

Lee, Hajeong; Park, Hayne Cho; Yoon, Hyun Bae; Han, Seung Seok; Cha, Ran Hui; Oh, Kook Hwan; Joo, Kwon Wook; Park, Sang Won; Lim, Chun Soo; Oh, Yun Kyu

Abstract

PURPOSE: Ciprofloxacin has been used as one of choice antibiotics for the empirical treatment of community-acquired acute pyelonephritis (APN), of which E-coli is the main causative bacterium. Recently, however, some studies show that ciprofloxacin-resistant E.coli is increasing in APN. In this study, authors aimed to re-evaluate ciprofloxacin as one of initial antibiotics for APN according to the survey of the patients' clinical and microbiologic characteristics. METHOD: In this single center, the records of patients diagnosed as APN were reviewed retrospectively who visited emergency room or out-patient clinic from Aug. 01, 2005 to Jul. 31, 2007. RESULT: A total of 303 patients were enrolled. The proportion of males to females was 1:9.4, the average age was 49.3+/-19 years old. Complicated APNs were 121 out of 303 patients, diabetes ranked highest, 52.5% (64/121). According to the urine culture analysis, the patients with isolated microorganism reached up to 45.2% (137/303) and E.coli occupied 94.2% out of total. As the initial antibiotics, ciprofloxacin was most commonly used (64.4%, 195/303), next was the 3rd generation cephalosporin (23.8%, 72/303). The analysis of antibiotics sensitivity demonstrated ciprofloxacin susceptibility was 81.4%, whereas high over 90% in the 3rd generation cephalosporin. When the ciprofloxacin-resistant E.coli was isolated, the patients tended to have prolonged duration of antibiotics treatment, a higher proportion of complicated APNs and of treatment non-responders.
CONCLUSION
For the APNs, ciprofloxacin is clinically effective initial antibiotics; however, it should be carefully used especially in case of the patients having combined underlying disease or the aged.