Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4342-4348
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4342
Predictive factors for early clinical response in community-onset Escherichia coli urinary tract infection and effects of initial antibiotic treatment on early clinical response
Young Jun Kim, Jeong-Mi Lee, Jae-Hoon Lee
Young Jun Kim, Department of Internal Medicine, Wonkwang University College of Medicine, Iksan 54538, South Korea
Jeong-Mi Lee, Department of Public Health, Wonkwang University College of Medicine, Iksan 54538, South Korea
Jae-Hoon Lee, Department of Internal Medicine and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan 54538, South Korea
Author contributions: Kim YJ designed the study and collected the data and drafted the article; Lee JM analyzed the data; Lee JH supervised the study and revised the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of WKUH 2020-03-023.
Informed consent statement: This study only was a review of non-identified existing recordings. So, the informed consent was exempt from IRB.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jae-Hoon Lee, MD, PhD, Doctor, Professor, Department of Internal Medicine and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, 460, Iksandaero, Iksan 54538, South Korea. john7026@wku.ac.kr
Received: May 8, 2020
Peer-review started: May 8, 2020
First decision: May 21, 2020
Revised: June 1, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 6, 2020
Processing time: 142 Days and 15 Hours
Abstract
BACKGROUND

Urinary tract infection (UTI) is a common disease. It often requires hospitalization, and severe presentations, including sepsis and other complications, have a mortality rate of 6.7%-8.7%.

AIM

To evaluate the predictive factors for early clinical response and effects of initial antibiotic therapy on early clinical response in community-onset Escherichia coli (E. coli) urinary tract infections (UTIs).

METHODS

This retrospective study was conducted at Wonkwang University Hospital in South Korea between January 2011 and December 2017. Hospitalized patients (aged ≥ 18 years) who were diagnosed with community-onset E. coli UTI were enrolled in this study.

RESULTS

A total of 511 hospitalized patients were included. 66.1% of the patients had an early clinical response. The mean length of hospital stay in patients with an early clinical response were each 4.3 d shorter than in patients without an early clinical response. In the multiple regression analysis, initial appropriate antibiotic therapy (OR = 2.449, P = 0.006), extended-spectrum β-lactamase (ESBL)-producing E. coli (OR = 2.112, P = 0.044), improper use of broad-spectrum antimicrobials (OR = 0.411, P = 0.006), and a stay in a healthcare facility before admission (OR = 0.562, P = 0.033) were the factors associated with an early clinical response. Initial broad-spectrum antibiotic therapy was not associated with an early clinical response.

CONCLUSION

ESBL producing E. coli, and the type of residence before hospital admission were the factors associated with an early clinical response. Appropriateness of initial antibiotic therapy was a predictive factor for an early clinical response, but broad-spectrum of initial antibiotic therapy did not impact early clinical response.

Keywords: Escherichia coli; Urinary tract infections; Adult; Community acquired infections

Core Tip: It is necessary to evaluate the clinical response of patients with urinary tract infections (UTIs) after 72 h of antibiotic therapy as poor clinical response has been related to clinical failure. We performed a single center retrospective study including 511 hospitalized patients (aged ≥ 18 years) who were diagnosed with community-onset Escherichia coli (E. coli) UTI. Among them, 66.1% of the patients had an early clinical response. Patients with an early clinical response had a shorter length of stay (4.3 d) and an earlier defervescence (64 h) than those without an early clinical response. An appropriate initial antibiotic therapy, extended-spectrum β-lactamase-producing E. coli, and a stay in a healthcare facility before admission were factors associated with an early clinical response. However, the initial broad-spectrum antibiotic therapy or initial severe presentations did not impact early clinical response.