Risk factors for quinolone-resistance in women presenting with Escherichia coli acute pyelonephritis.

Abstract:

UNLABELLED:In France, according to the National Epidemiology Observatory of Bacterial Resistance to Antibiotics, 15.3% of outpatient urinary Escherichia coli isolates were fluoroquinolone-resistant in 2010. This puts to question the relevance of empirical fluoroquinolone therapy for community-acquired acute pyelonephritis (APN), potentially severe infections. OBJECTIVES:We had for aim to identify individual risk factors for quinolone-resistant E. coli in community-acquired APN. PATIENTS AND METHODS:A retrospective cohort study of 344 adult female patients presenting with E. coli APN was conducted at the Roanne and Saint-Etienne hospital emergency departments, from January 2011 to February 2012. We studied the demographic, administrative, and clinical factors. E. coli strains with intermediate susceptibility on the antibiogram were considered as resistant. RESULTS:There was 23% of isolates that were resistant to nalidixic acid and 17.4% to ofloxacin. Complicated APN was not a significant risk factor (univariate analysis). Three risk factors of resistance to nalidixic acid and ofloxacin were independent (multivariate analysis): fluoroquinolone use in the previous 3 months, hospitalization in the previous 6 months, and stay in a long-term care facility. The resistance to ofloxacin reached 30.6% if at least 1 of these risk factors was present; it was 9% when none of the factors were present. CONCLUSIONS:These results suggest that local recommendations for the empirical therapy of APN should be reviewed. The limitations of our study require backing up our results with prospective multicentric studies that could lead to drafting new national recommendations.

journal_name

Med Mal Infect

authors

Bedoin M,Cazorla C,Lucht F,Berthelot P,Boyer M,Carricajo A,Guérin T,Viallon A

doi

10.1016/j.medmal.2014.02.003

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

206-16

issue

5

eissn

0399-077X

issn

1769-6690

pii

S0399-077X(14)00048-1

journal_volume

44

pub_type

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