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 Original Articles |
| Antibiotic Sensitivity of the Causative Organisms and Use of Antibiotics in Women with Community-Acquired Acute Pyelonephritis |
| Wie, Seong-Heon /Choi, Su-Mi/Lee, Dong-Gun/Kim, Soo-Young/Kim, Sang-Il/Yoo, Jin-Hong/Shin, Wan-Shik |
| Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea. Department of Clinical Pathology, School of Medicine, The Catholic University of Korea, Seoul, Korea. |
Vol.34 Num.6 (p353~359)
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Background : Acute pyelonephritis in women can be treated with trimethoprim-sulfamethoxazole (SXT), fluoroquinolone, aminoglycosides, second- and third-generation cephalosporins. The purpose of this study is to provide basic informations for the choice of the most effectve and economic first-line antibiotics among several agents to clinicians, who manage community-acquired acute pyelonephritis.
Methods : We investigated antibiotic sensitivities of 130 organisms isolated from urine culture of 165 patients, who admitted to Catholic University St. Vin-cent´s Hospital due to community-acquired acute pyelonephritis from February 2001 to November 2002. All those patients had more than 105 cfu/mL on urine culture and we analyzed the usage of antibiotics and clinical course in those patients.
Results : Among 130 isolates, 120 isolates were E. coli, 6 K. pneumoniae, 1 K. oxytoca, 1 Enterobacter aerogenes and 2 Proteus mirabilis. Among 120 E. coli, the rates of resistance were 59.2% to piperacillin, 58.3% to cephalothin, 36.7% to sulfamethoxazole, 19.2 % to gentamicin, and 7.5% to ciprofloxacin in order. For 120 E. coli isolates, 100%, 99.2%, 99.2%, 99.2%, and 97.5% were susceptible to imipenem, cefotaxime, cefuroxime, amikacin, and piperacillin/tazobactam, respectively. Among 165 patients, 130 patients who had positive urine or blood culture, were divided into three
groups according to the first-line antibiotics administered on the day of admission. Gentamicin (5 mg/kg q 24h) were infused to 90 patients, and 9 (10%) of 90 patients revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria in group I. Cefuroxime were administered to 36 patients in group II and all 36 patients revealed evidences of clinical success such as defervescence and absence of pyuria. Intravenous antibiotics changed to oral administration of the first-, second-cephalosporin, and trimethoprimsulfamethoxazole in all patients except one patient, who received oral fluoroquinolone according to the results of antibiotic sensitivities.
Conclusion : Cefuroxime, amikacin, and the third-generation cephalosporins showed excellent antibacterial activity against isolated organisms from women with acute pyelonephritis in this study, and gentamicin could be used as initial empiric regimen with careful monitoring of clinical response and antibiotic sensitivities of isolated microorganisms. These findings would be useful informations to physicians, who are trying to use low-priced antibiotics with narrow spectrum antibacterial activity, sparing more expensive and broad spectrum antibiotics in managing urinary tract infections. |
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Keywords : Acute pyelonephritis, Antibiotics, Gentamicin, Cefuroxime |
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