Infect Chemother.  2012 Aug;44(4):269-274. 10.3947/ic.2012.44.4.269.

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?

• Kim B
• Kim J
• Wie SH
• Park SH
• Cho YK
• Lim SK
• Shin SY
• Yum JS
• Lee JS
• Kweon KT
• Lee H
• Cheong HJ
• Park DW
• Ryu SY
• Chung MH
• Pai H

• KMID: 2045546
• DOI: http://doi.org/10.3947/ic.2012.44.4.269

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.

Keyword

Cystitis; Pyelonephritis; Antibiotic; Resistance; Community

MeSH Terms

Anti-Bacterial Agents
Cephalosporins
Ciprofloxacin
Cystitis
Escherichia coli
Insurance
Korea
Pyelonephritis
Retrospective Studies
Anti-Bacterial Agents
Cephalosporins
Ciprofloxacin

Figure

• 

  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

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