Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis

Takahashi, Satoshi; Kurimura, Yuichiro; Takeyama, Koh; Hashimoto, Kimio; Miyamoto, Shintaro; Ichihara, K; Igarashi, Michelle; Hashimoto, Jiro; Furuya, Ryoji; Hara, Hiroshi; Uchida, Kohsuke; Miyao, Noriomi; Yanase, Masahiro; Takagi, Yoshio; Tachiki, Hitoshi; Taguchi, Keisuke; Tsukamoto, Taiji

doi:10.1007/s10156-009-0721-9

Cited by 15 publications

(14 citation statements)

References 12 publications

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“…APN associated with surgical intervention was excluded in order to minimize potential bias for evaluating the risk factors in APN with upper urinary calculi. Antimicrobial treatment for initial empirical treatment was performed according to the antimicrobial treatment guidelines published by the Japanese Association for Infectious Disease and the Japanese Society of Chemotherapy that a cephalosporin, penicillin with a beta-lactamase inhibitor, an aminoglycoside, and a carbapenem, followed by oral antimicrobial treatment, are recommended [1]. The midstream and blood culture were performed in all patients, and antimicrobial susceptibility test also was examined.…”

Section: Methodsmentioning

confidence: 99%

Predictors of septic shock in obstructive acute pyelonephritis

et al. 2013

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PurposeAcute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.ResultsOverall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.ConclusionPatients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.

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Section: Methodsmentioning

confidence: 99%

Predictors of septic shock in obstructive acute pyelonephritis

et al. 2013

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“…Additionally, the early clinical success rates at 72 h after the start of the cefuroxime or cefotaxime therapy were not significantly different (81.1% versus 78.9%, respectively). Although complicated APN is a common disease entity that physicians have to manage, the efficacies of different antibiotics are not established for the treatment of complicated APN based on subclassifications, such as nonobstructive or obstructive or health care-associated complicated APN types, because most clinical evidence on antimicrobial therapy is from uncomplicated APN cases (2,3,16). In this study, we found that the cefuroxime efficacies were comparable to the cefotaxime efficacies, and these data suggest that cefuroxime and extended-spectrum cephalosporins, such as cefotaxime, can also be used as an initial antimicrobial agent for the treatment of community-onset complicated nonobstructive APN.…”

Section: Discussionmentioning

confidence: 99%

“…Complicated APN was defined as APN and the presence of any of the following: urinary tract abnormalities (e.g., vesicoureteral reflux, urolithiasis, neurogenic bladder, polycystic kidney disease, or anomaly of urinary tract), comorbid conditions (e.g., chronic liver disease, chronic kidney disease, congestive heart failure, diabetes mellitus, immunosuppression, kidney transplantation, malignancy, and pregnancy), or age Ͼ 65 years (2,3,12). Finally, women age Ն18 years with community-onset nonobstructive complicated APN who initially received either cefuroxime or cefotaxime were included in the study.…”

Section: Methodsmentioning

confidence: 99%

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Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

Chang

Kim

Wie

2015

Antimicrob Agents Chemother

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This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n ‫؍‬ 156) were compared with those of a cefotaxime-treated group (n ‫؍‬ 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P ‫؍‬ 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/ 89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P ‫؍‬ 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-␤-lactamase-producing Enterobacteriaceae, C-reactive protein levels of >15 mg/dl, and white blood cell counts of >15,000/mm 3 of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women. C ommunity-onset complicated acute pyelonephritis (APN) includes nonobstructive complicated APN and obstructive complicated APN, with the obstructive form requiring drainage and antimicrobial treatment. Extended-spectrum cephalosporin, penicillin with a ␤-lactamase inhibitor, an aminoglycoside, and a carbapenem are recommended as the initial antimicrobial agents for the treatment of complicated APN, which includes urosepsis, obstructive complicated APN, and health care-associated catheter-associated complicated APN (1-3).However, we hypothesized that more step-down antibiotics, such as cefuroxime, can effectively be used for the treatment of community-onset nonobstructive complicated APN, the patient population of which is more homogeneous and the uropathogens are more susceptible to cephalosporin treatment than those for the obstructive form (4, 5). The antimicrobial susceptibilities of uropathogens in community-onset nonobstructive complicated APN may be more similar to those in uncomplicated APN rather than those in health care-associated or catheter-associated urinary tract infections (UTIs).In the classification of UTIs and APNs, community-onset diabetic or elderly women with APN are usually included in the complicated APN subtype and may be treated initially with antimicrobial agents, which are recommended for compli...

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“…Among the several urological disorders correlated with complicated APN [3, 4], urinary tract stone disease is one of the most common [5, 6]. It is well recognized that emergency drainage to decompress the collecting system of infected kidneys is the essential urological intervention for patients with calculous APN [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Uroseptic Shock in Patients with Urolithiasis-Related Acute Pyelonephritis

et al. 2017

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Objectives: To analyze the risk factors of uroseptic shock induced by calculous acute pyelonephritis (APN). Methods: This study included 69 patients (41 were women and 28 were men) who were admitted to our hospital for APN treatment associated with urolithiasis during the period from January 2005 to December 2012. We reviewed the electronic medical records of these patients to analyze risk factors contributing to the development of uroseptic shock from APN in patients with urolithiasis. Results: Urinary drainage with ureteral stent or nephrostomy was carried out in 62 cases. Septic shock requiring vasopressor infusion against circulatory collapse was observed in 25 patients, these patients showed significantly lower serum albumin levels and higher C-reactive protein (CRP) compared to patients who did not exhibit septic shock. Multivariate analysis revealed that serum albumin level and CRP were the significant risk factors for the development of uroseptic shock from calculous APN. Conclusions: Serum albumin level was the significant risk factor for the development of uroseptic shock from calculous APN. Emergency drainage to decompress the obstructed urinary tract is mandatory as an initial urological intervention for the patients with lower serum albumin level.

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Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis

Cited by 15 publications

References 12 publications

Predictors of septic shock in obstructive acute pyelonephritis

Predictors of septic shock in obstructive acute pyelonephritis

Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

Risk Factors for Uroseptic Shock in Patients with Urolithiasis-Related Acute Pyelonephritis

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