Infect Chemother. 2012 Aug;44(4):269-274. Korean.
Published online Aug 31, 2012.
Copyright © 2012 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
Original Article

Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea?

Bongyoung Kim,1 Jieun Kim,1 Seong-heon Wie,2 Sun Hee Park,2 Young Kyun Cho,3 Seung-Kwan Lim,4 Sang Yop Shin,5 Joon Sup Yum,6 Jin Seo Lee,7 Ki Tae Kweon,8 Hyuck Lee,9 Hee Jin Cheong,10 Dae Won Park,10 Seong Yeol Ryu,11 Moon-Hyun Chung,12 and Hyunjoo Pai1
    • 1Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea.
    • 2Department of Internal Medicine, Catholic University, College of Medicine, Seoul, Korea.
    • 3Department of Internal Medicine, Gacheon University, College of Medicine, Gacheon, Korea.
    • 4Department of Internal Medicine, Ajou University, College of Medicine, Suwon, Korea.
    • 5Department of Internal Medicine, Jeju University, College of Medicine, Jeju, Korea.
    • 6Department of Internal Medicine, Sungkyunkwan University, College of Medicine, Seoul, Korea.
    • 7Department of Internal Medicine, Hallym University, College of Medicine, Seoul, Korea.
    • 8Department of Infectious disease, Patima Hospital, Daegu, Korea.
    • 9Department of Internal Medicine, Donga University, College of Medicine, Daegu, Korea.
    • 10Department of Internal Medicine, Korea University, College of Medicine, Seoul, Korea.
    • 11Department of Internal Medicine, Gyemyeong University, College of Medicine, Daegu, Korea.
    • 12Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea.
Received November 24, 2011; Revised April 06, 2012; Accepted April 09, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Uncomplicated acute cystitis (CA-UAC) is one of the most common infections treated with antibiotics in the community. However, few data on etiology of CA-UAC and its susceptibility to antibiotics are available, primarily because, in Korea, insurance does not allow reimbursement for microbiological evaluation of CA-UAC. However, microbiologic data on community-acquired uncomplicated acute pyelonephritis (CA-UAPN) are available. The objective of the study was to evaluate the question of whether microbiologic data on CA-UAPN can be used for treatment of CA-UAC; therefore, etiology and antimicrobial susceptibility were compared between pathogens of CA-UAC and those of CA-UAPN.

Materials and Methods

During 2008, 538 CA-UACs and 1,265 CA-UAPNs were recruited retrospectively from 14 hospitals (UTI research group). Microbiologic data on etiology and susceptibility to antibiotics were collected retrospectively.

Results

Urine culture was positive in 131 CA-UACs (131/469, 27.9%) and 719 CA-UAPNs (719/1249, 57.6%). Escherichia coli was the most common pathogen in both groups [83.2% (109/131) in CA-UAC vs. 91.9% (661/719) in CA-UAPN]. Susceptibility to common UTI regimens, such as ciprofloxacin, extended-spectrum cephalosporins, and trimethoprim/sulfamethoxazole did not differ between urinary pathogens of CA-UACs and CA-UAPNs, however, a significant difference was observed in rates of resistance to ampicillin/sulbactam (16.5% vs. 42.9%, P<0.001, respectively).

Conclusions

Rates of resistance of E. coli from CA-UAC and CA-UAPN to most antibiotics did not differ. For proper treatment, further microbiological evaluation for CA-UAC is mandatory.

Keywords
Cystitis; Pyelonephritis; Antibiotic; Resistance; Community

Figures

Figure 1
Co-resistance of E. coli from CA-UAC and CA-APN to several antibiotics (The size of the circle reflects the rate of resistance).

CA-UAC, Community-acquired uncomplicated acute cystitis; CA-UAPN, Community-acquired uncomplicated acute pyelonephritis SXT, Trimethoprim/sulfamethoxazole; CIP, Ciprofloxacin; ESBL, Extended-specturm beta-lactamase; R, Resistance

Tables

Table 1
Identified Pathogens of CA-UAC and CA-UAPN

Table 2
Antibiotic Susceptibility of E. coli from CA-UAC and CA-UAPN

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