Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4342
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
Urinary tract infection (UTI) often requires hospitalization, and patients with severe presentations, including sepsis and other complications, have a mortality rate of 6.7%-8.7%. It is necessary to evaluate the clinical response of patients with UTIs after 72 h of antibiotic therapy as poor clinical response after 72 h of antibiotic therapy has been related to clinical failure. There has been an increase in the incidence of community-onset UTIs due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli). These findings have increased the use of initial broad-spectrum antimicrobials in patients with UTIs. However, use of broad-spectrum antimicrobials result in nosocomial acquisition of antimicrobial-resistant bacteria or occurrence of Clostridium difficile infections.
The assessment of predictive factors for early clinical response may be helpful in the treatment of community-onset UTIs.
The primary aim of this study was to evaluate the clinical significance of early clinical response in community-onset E. coli UTIs and the impact of severe presentations and initial antibiotic therapy on this early clinical response.
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. Patients who were transferred to another hospital during treatment and those who had other concurrent infectious diseases were excluded.
A total of 511 hospitalized patients were included. Among them, 66.1% of the patients had an early clinical response. Patients with an early clinical response had a shorter length of hospital stay (4.3 d) and an earlier defervescence (64 h) than those without an early clinical response. An appropriate initial antibiotic therapy (OR = 2.449, P = 0.006), ESBL-producing E. coli (OR = 2.112, P = 0.044), and a stay in a healthcare facility before admission (OR = 0.562, P = 0.033) were the factors associated with an early clinical response. However, the initial broad-spectrum antibiotic therapy or initial severe presentations such as initial septic shock, concurrent bacteremia, and acute renal failure did not impact early clinical response.
Patients with an early clinical response to community onset E. coli UTI had a shorter length of hospital stay and an earlier defervescence. Appropriate initial antibiotic therapy was a good predictive factor for an early clinical response. However, initial broad-spectrum antibiotic therapy or initial severe presentation did not impact early clinical response. Physicians need to restrictively use initial broad-spectrum antimicrobials to treat patient suspected of having multi-drug resistant pathogens.
Initial appropriate antibiotic therapy was a good predictive factor for an early clinical response. However, both the initial use of broad-spectrum antimicrobials and improper broad-spectrum antibiotic therapy did not improve the early clinical response in patients with community-onset UTI. The study results suggest that initial broad-spectrum antimicrobials should be used to treat patients suspected with multi-drug resistant pathogenic infection, instead of patients with septic shock, concurrent bacteremia, and acute renal failure.