Clinical effectiveness of oral antimicrobial therapy for acute pyelonephritis caused by extended-spectrum β-lactamase-producing Enterobacteriales

  • Si-Ho Kim
  • Kyoung Ree Lim
  • Hyunju Lee
  • Kyungmin Huh
  • Sun Young Cho
  • Cheol-In Kang
  • Doo Ryeon Chung
  • Kyong Ran PeckEmail author
Original Article


Infections caused by extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are commonly treated with intravenous antibiotics. This study investigated whether oral antimicrobial therapy (OAT) is as effective as intravenous antimicrobial therapy (IVT) for acute pyelonephritis (APN) caused by ESBL-PE. A retrospective cohort of patients with APN caused by ESBL-PE was studied at a tertiary-care hospital from January 2014 through December 2016. The OAT group comprised patients treated with an appropriate oral antimicrobial agent following 7 days or less of IVT. The primary endpoint was treatment failure defined as clinical and/or microbiological failure. The secondary endpoint was length of hospital stay and recurrences of APN within 2 months and within 1 year. Propensity score matching and multivariable Cox proportional hazard modeling were used to minimize bias. Among 238 eligible cases, Escherichia coli (83.6%) was the most common pathogen. Sixty patients received OAT after a median of four days of appropriate IVT, and 178 patients completed treatment with IVT. Fluoroquinolones (58.3%) were the most commonly prescribed OAT, followed by trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. OAT was not associated with treatment failure (adjusted OR 0.66; 95% CI 0.18–2.44) and hospitalization length was shorter in the OAT group (6.2 days versus 10.7 days; P < 0.01). APN recurrence caused by ESBL-PE infection within 2 months was not associated with OAT (adjusted HR 0.56; 95% CI 0.16–2.00). OAT reduced hospital stay without adverse effects on treatment outcome. OAT could be safely applied as a carbapenem-saving option in treatment of APN.


Acute pyelonephritis Extended-spectrum β-lactamase Oral antimicrobial therapy Antibiotics stewardship 



The authors thank the Statistics and Data Center at Samsung Medical Center for their statistical support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

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

Supplementary material

10096_2019_3705_MOESM1_ESM.docx (60 kb)
ESM 1 (DOCX 60 kb)


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Copyright information

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

Authors and Affiliations

  • Si-Ho Kim
    • 1
  • Kyoung Ree Lim
    • 2
  • Hyunju Lee
    • 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
  2. 2.Department of Medicine, College of MedicineKangwon National UniversityChuncheonSouth Korea

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