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To evaluate the frequency and appropriateness of indwelling urinary catheters (IUC) use and the incidence of catheter-associated urinary tract infections (CA-UTI), and explore the risk factors for CA-UTI in hospitals as a whole, we conducted a study. This study was divided into two parts; a point-prevalence study on Dec 12th 2012 and a prospective cohort study from Dec 13th 2012 to Jan 9th 2013 were performed in six hospitals in Korea. All hospitalized patients with newly-placed IUCs were enrolled and monitored weekly for 28 days after IUC placement. In the point-prevalence study, the IUCs were present in median 14.9/100 hospitalized patients (1Q 14, 3Q 16) across the six hospitals. In the prospective cohort study, the median IUC-days per patient was 5 (1Q 3, 3Q 10) and the median CA-UTI prevalence per 1,000 catheter days was 1.9 (1Q 0.7, 3Q 3.8) with significant inter-hospital variation. The proportion of patients with inappropriate IUC maintenance increased with number of IUC-days (8.5% on day 7, 9.4% on day 14, 16.3% on day 21, and 23.1% on day 28). Urinary output monitoring (23/36, 63.9%) was the most common indication for inappropriate use after 1 week of ICU placement. In multivariate analysis, IUC-days was significantly associated with the development of CA-UTI (odds ratio 1.122, 95% confidence interval 1.074-1.173, P< 0.001). IUC-days and CA-UTI rates vary between hospitals. IUC-days is a risk factor for CA-UTI, and is correlated with inappropriate use.

Background: Klebsiella pneumoniae with hypermucoviscosity (HM) phenotype is generally more virulent than HM-negative strains. The aim of this study was to investigate the prevalence of HM phenotype among urinary isolates and to compare the virulence factors, antimicrobial susceptibility patterns and clinical characteristics of HM-positive and -negative K. pneumoniae isolated from urine of hospitalized patients., Methods: From June to October 2013, a total of 81 non-repetitive K. pneumoniae strains were isolated from urine. HM phenotype was determined by a string test. The K1 and K2 genotypes, the allS, kfu, rmpA, rmpA2 and wabG, aerobactin gene were detected by polymerase chain reaction., Results: Of the 81 K. pneumoniae isolates, 12.3% produced a positive string test. The aerobactin (80.0%[8/10] vs. 15.5%[11/71], p = .0001), allS (40.0%[4/10] vs. 9.9%[7/71], p = .009), rmpA (70.0%[7/10] vs. 14.1%[10/71], p = .0001) and rmpA2 (60.0%[6/10] vs. 16.9%[12/71], p = .002) genes were more prevalent in HM positive than in HM negative strains. The K1 (20.0%[2/10) vs. 8.5%[6/71]] and K2 (30.0%[3/10] vs. 4.2%[3/71]) capsular serotypes were more common in HM strains than in non-HM strains (p = .0001). HM-positive K. pneumoniae isolates were more susceptible to amoxicillin/clavulanic acid (p = .02), cefazolin (p = .03), cefotaxime (p = .02) and ciprofloxacin (p = .03) than HM-negative isolates. Multivariate analysis showed that HM phenotype (OR, 23.87; 95% CI, 3.91-145.4, p < .01) and age >60 years (OR, 8.33; 95% CI, 1.25-55.31, p = .03) were significant risk factors for concurrent bacteraemia., Conclusion: Klebsiella pneumoniae with expression of HM phenotype isolated from urine were more likely to be associated with concurrent bacteraemia than isolates without the HM phenotype, and were more susceptible to antibiotics. Physicians have to be aware of the possibility of bacteraemia in patients with K. pneumoniae bacteriuria, especially if strains are HM positive and the patient is >60 years old.

Background/aims: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli., Methods: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN., Results: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p = 0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319)., Conclusions: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

Background/aims: Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN., Methods: Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae., Results: Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm(3) in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393)., Conclusions: Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.

Objectives: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN)., Methods: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012., Results: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P = 0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P = 0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P < 0.001). However, more of them had C-reactive protein ≥20 mg/dL (40.7% vs. 27.4% P < 0.001), azotemia (29.3% vs. 13.4% P < 0.001) and bacteremia (53.7% vs. 38.2% P < 0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P = 0.169; 2.0% vs. 1.7%, P = 0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P < 0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P = 0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens., Conclusions: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients., (Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.