Clinical characteristics predicting early clinical failure after 72 h of antibiotic treatment in women with community-onset acute pyelonephritis: a prospective multicentre study.

Abstract

In patients with community-onset acute pyelonephritis (CO-APN), assessing the

risk factors for poor clinical response after 72 h of antibiotic treatment (early

clinical failure) is important. The objectives of this study were to define those

risk factors, and to assess whether early clinical failure influences mortality

and treatment outcomes. We prospectively collected the clinical and

microbiological data of women with CO-APN in South Korea from March 2010 to

February 2012. The numbers of cases in the early clinical success and early

clinical failure groups were 840 (79.1%) and 222 (20.9%), respectively. Final

clinical failure and mortality were higher in the early clinical failure group

than in the early clinical success group (14.9% vs 2.3%, p <0.001; 6.8% vs 0.1%,

p 0.001, respectively). In a multiple logistic regression model, the risk factors

for early clinical failure among the total 1062 patients were diabetes mellitus

(OR 1.5; 95% CI 1.1-2.1), chronic liver diseases (OR 3.3; 95% CI 1.6-6.7),

malignancy (OR 2.2; 95% CI 1.1-4.4), Pitt score >/=2 (OR 2.5; 95% CI 1.6-3.8),

presence of azotaemia (OR 1.8; 95% CI 1.2-2.7), white blood cell count >/=20

000/mm(3) (OR 2.5; 95% CI 1.6-4.0), serum C-reactive protein level >/=20 mg/dL

(OR 1.7; 95% CI 1.2-2.4), and history of antibiotic usage within the previous

year (OR 1.5; 95% CI 1.1-2.2). Analysing the subgroup of 743 patients with CO-APN

due to Enterobacteriaceae, fluoroquinolone resistance of the uropathogen was

another factor associated with early clinical failure (OR 1.7; 95% CI 1.1-2.5).

Simple variables of underlying diseases, previous antibiotic usage and initial

laboratory test outcomes can be used to decide on the direction of treatment in

CO-APN.