{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:10:56Z","timestamp":1790457056514,"version":"4.1.0"},"reference-count":40,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001) and had higher rates of previous urinary tract infections (UTIs) (56.5% versus 24.5%;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001) and previous antibiotic use (56.8% versus 22.8%;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001).\n            <jats:named-content content-type=\"genus-species\">Escherichia coli<\/jats:named-content>\n            was more frequently isolated from patients with CA-APN than from patients with HCA-APN (79.9% versus 50.5%;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001). The rates of resistance of\n            <jats:named-content content-type=\"genus-species\">Escherichia coli<\/jats:named-content>\n            strains from CA-APN patients versus HCA-APN patients were as follows: amoxicillin-clavulanic acid, 22.4% versus 53.2% (\n            <jats:italic>P<\/jats:italic>\n            = 0.001); cefuroxime, 7.7% versus 43.5% (\n            <jats:italic>P<\/jats:italic>\n            = 0.001); cefotaxime, 4.3% versus 32.6% (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001); ciprofloxacin, 22.8% versus 74.5% (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001); and co-trimoxazole, 34.5% versus 58.7% (\n            <jats:italic>P<\/jats:italic>\n            = 0.003). The site of acquisition, recurrent UTIs, and previous antibiotic use were independent risk factors for antimicrobial resistance. Relapse rates were significantly higher when definitive antimicrobial treatment was not adequate (37.1% versus 9.3% when definitive antimicrobial treatment was adequate;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001). Our study reflects the rise of resistance to commonly used antibiotics in acute pyelonephritis. In order to choose the adequate empirical antibiotic therapy, risk factors for resistance should be considered.\n          <\/jats:p>","DOI":"10.1128\/aac.01317-17","type":"journal-article","created":{"date-parts":[[2017,10,3]],"date-time":"2017-10-03T00:30:26Z","timestamp":1506990626000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":20,"title":["A Cohort Study of Risk Factors That Influence Empirical Treatment of Patients with Acute Pyelonephritis"],"prefix":"10.1128","volume":"61","author":[{"given":"Pau","family":"Bosch-Nicolau","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicen\u00e7","family":"Falc\u00f3","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Vi\u00f1ado","sequence":"additional","affiliation":[{"name":"Microbiology Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Andreu","sequence":"additional","affiliation":[{"name":"Microbiology Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Len","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benito","family":"Almirante","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carles","family":"Pigrau","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Aut\u00f3noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/519268"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.purol.2013.03.009"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2010.02.042"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1157\/13073144"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/378291"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0086634"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2013.03.022"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1157\/13070401"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aprim.2011.11.005"},{"issue":"46","key":"e_1_3_2_11_2","article-title":"ECDC publishes 2014 surveillance data on antimicrobial resistance and antimicrobial consumption in Europe","volume":"20","author":"Eurosurveillance Editorial Team","year":"2015","unstructured":"Eurosurveillance Editorial Team. 2015. 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