Inappropriate empirical antibiotic therapy does not adversely affect the clinical outcomes of patients with acute pyelonephritis caused by extended-spectrum β-lactamase-producing Enterobacteriales

  • Si-Ho Kim
  • Suhyun Oh
  • Kyungmin Huh
  • Sun Young Cho
  • Cheol-In Kang
  • Doo Ryeon Chung
  • Kyong Ran PeckEmail author
Original Article


Extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are often associated with inappropriate empirical therapy (IAT). The aim of this study was to investigate whether IAT of acute pyelonephritis (APN) caused by ESBL-PE is related to adverse outcomes. A retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Patients who had APN caused by ESBL-PE and were definitely treated with appropriate antibiotics for at least 7 days were enrolled. IAT was defined as when inappropriate empirical antibiotics were given 48 h or longer after initial diagnosis of APN. Primary endpoint was treatment failure defined as clinical and/or microbiologic failure. Secondary endpoints were length of hospital stay and recurrence of APN. Propensity score matching was used to adjust heterogeneity of each group. Among 175 eligible cases, 59 patients received IAT and 116 patients received appropriate empirical antimicrobial therapy (AT). Treatment failure was observed in five (8.4%) patients and nine (7.8%) patients in each group, respectively. After matching, the treatment failure rate was similar between both groups (adjusted odd ratio [aOR] 1.05; 95% confidence index [CI] 0.26–4.15). The length of hospital stay (median 11 days in the IAT group versus 11 days in the AT group; P = 0.717) and absence of recurrence within 2 months (90.3% in IAT and 86.7% in AT; P = 0.642) were also similar. IAT did not adversely affect the clinical outcome. In this regard, clinicians should be more cautious about indiscriminate prescription of broad-spectrum antibiotics such as carbapenem empirically for treatment of APN possibly caused by ESBL-PE.


Acute pyelonephritis Extended-spectrum β-lactamase Empirical antimicrobial therapy Enterobacteriales 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical statement

The study was approved by the local ethical research committee (IRB number: 2018–05-089).

Supplementary material

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ESM 1 (DOCX 16 kb)
10096_2019_3528_MOESM2_ESM.docx (23 kb)
ESM 2 (DOCX 22 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Si-Ho Kim
    • 1
  • Suhyun Oh
    • 1
  • Kyungmin Huh
    • 1
  • Sun Young Cho
    • 1
  • Cheol-In Kang
    • 1
  • Doo Ryeon Chung
    • 1
  • Kyong Ran Peck
    • 1
    Email author
  1. 1.Division of Infectious Diseases, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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