Yonsei Med J.  2012 Jan;53(1):164-171. 10.3349/ymj.2012.53.1.164.

Change of Antimicrobial Susceptibility among Escherichia coli Strains Isolated from Female Patients with Community-Onset Acute Pyelonephritis

  • 1Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea. yhwa1805@ajou.ac.kr
  • 2Department of Nephrology, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Korea.


There is a concern on which antimicrobials are appropriate as empirical agents for community-onset acute pyelonephritis (APN) in regions where the fluoroquinolone resistance rate is high, such as in Korea.
Three hundred and two strains of E. coli in 2001-2002 and 349 strains in 2008-2009 were isolated from the urine cultures of female adult APN patients, and the antimicrobial susceptibility was compared according to each study period. All the patients were classified as uncomplicated or complicated APN, and a subgroup analysis was done thereafter.
The E. coli strains isolated in 2008-2009 showed improved susceptibility to trimethoprim-sulfamethoxazole compared to those isolated in 2001-2002. However, the third generation cephalosporin and gentamicin susceptibility was worsened. Of the 232 isolates from the uncomplicated APN patients, there was no difference between the two different time periods. On the other hand, of the 419 isolates from the complicated APN patients, the susceptibility to third generation cephalosporin, gentamicin and ciprofloxacin was significantly worsened.
The antimicrobial susceptibility of E. coli changed over the study period, however, this change occurred mainly in the complicated APN patients. In Korea, ciprofloxacin is still useful as an empirical agent for uncomplicated APN patients, but this is not the case for patients with complicated APN because of high resistance rate to ciprofloxacin in these patients. For the complicated APN patients, the rate of resistance to ciprofloxacin is already more than 30%.


Escherichia coli; antimicrobial resistance; acute pyelonephritis; ciprofloxacin resistance

MeSH Terms

Acute Disease
Anti-Bacterial Agents/*therapeutic use
Ciprofloxacin/*therapeutic use
Community-Acquired Infections/*drug therapy/microbiology
*Drug Resistance, Bacterial
Escherichia coli Infections/*drug therapy/microbiology
Middle Aged
Pregnancy Complications, Infectious/drug therapy/microbiology
Pyelonephritis/*drug therapy/microbiology


  • Fig. 1 Comparison of the antimicrobial susceptibilities of the E. coli isolated between 2001-2002 versus that of 2008-2009. (A) All the study subjects (n=651). (B) The uncomplicated APN subgroup (n=232). (C) The complicated APN subgroup (n=419). The asterisk means a p value <0.05. AMC, ampicillin; AP-BLI, aminopenicillin and beta-lactamase inhibitor; GM, gentamicin; AMK, amikacin; SXT, trimethoprim-sulfamethoxazole; CPFX, ciprofloxacin; 3Ceph, third generation cephalosporin; IMPM, imipenem.


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