Korean Journal of Nephrology 2008;27(6):688-695.
Causative Organisms and Antibiotics Sensitivity in Community Acquired Acute Pyelonephritis
Hajeong Lee, M.D.2, Hayne Cho Park, M.D.2, Hyun-Bae Yoon, M.D.2, Seung Seok Han, M.D.2, Cha Ran-hui, M.D.2, Kook-Hwan Oh, M.D.2, Kwon Wook Joo, M.D.2, Sang Won Park, M.D.1, Chun Soo, Lim, M.D.1, Yun Kyu Oh, M.D.1
Department of Internal Medicine1
Seoul National University Boramae Hospital, Department of Internal Medicine2
Seoul National University college of Medicine, Seoul, Korea
임상연구 : 지역사회 획득 급성 신우신염의 원인균 및 ciprofloxacin 저항성에 대한 연구
이하정2, 박혜인조2, 윤현배2, 한승석2, 차란희2, 오국환2, 주권욱2, 박상원1, 임춘수1, 오윤규1
서울대학교 보라매병원 내과1, 서울대학교 의과대학 내과학교실2
Abstract
Purpose : Ciprofloxacin has been used as one of choice antibiotics for the empirical treatment of community-acquired acute pyelonephritis (APN), of which E-coli is the main causative bacterium. Recently, however, some studies show that ciprofloxacin-resistant E.coli is increasing in APN. In this study, authors aimed to re-evaluate ciprofloxacin as one of initial antibiotics for APN according to the survey of the patients' clinical and microbiologic characteristics. Method : In this single center, the records of patients diagnosed as APN were reviewed retrospectively who visited emergency room or out-patient clinic from Aug. 01, 2005 to Jul. 31, 2007. Result : A total of 303 patients were enrolled. The proportion of males to females was 1:9.4, the average age was 49.3±19 years old. Complicated APNs were 121 out of 303 patients, diabetes ranked highest, 52.5% (64/121). According to the urine culture analysis, the patients with isolated microorganism reached up to 45.2% (137/303) and E.coli occupied 94.2% out of total. As the initial antibiotics, ciprofloxacin was most commonly used (64.4%, 195/303), next was the 3rd generation cephalosporin (23.8%, 72/303). The analysis of antibiotics sensitivity demonstrated ciprofloxacin susceptibility was 81.4%, whereas high over 90% in the 3rd generation cephalosporin. When the ciprofloxacin-resistant E.coli was isolated, the patients tended to have prolonged duration of antibiotics treatment, a higher proportion of complicated APNs and of treatment non-responders. Conclusion : For the APNs, ciprofloxacin is clinically effective initial antibiotics; however, it should be carefully used especially in case of the patients having combined underlying disease or the aged.
Key Words: Pyelonephritis, E.coli, Ciprofloxacin resistance
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