Korean J Intern Med.  2016 Jan;31(1):145-155. 10.3904/kjim.2016.31.1.145.

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

• Chang UI
• Kim HW
• Wie SH

• KMID: 2373783
• DOI: http://doi.org/10.3904/kjim.2016.31.1.145

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.

Keyword

Cefuroxime; Acute pyelonephritis; Escherichia coli

MeSH Terms

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
Anti-Bacterial Agents
Cefuroxime