Predictive factors for early clinical response in community-onset Escherichia coli urinary tract infection and effects of initial antibiotic treatment on early clinical response

Abstract

BACKGROUND Urinary tract infection (UTI) is a common disease. It often requires hospitalization, and severe presentations, including sepsis and other complications, have a mortality rate of 6.7%-8.7%. AIM To evaluate the predictive factors for early clinical response and effects of initial antibiotic therapy on early clinical response in community-onset Escherichia coli (E. coli) urinary tract infections (UTIs). METHODS This retrospective study was conducted at Wonkwang University Hospital in South Korea between January 2011 and December 2017. Hospitalized patients (aged > 18 years) who were diagnosed with community-onset E. coli UTI were enrolled in this study. RESULTS A total of 511 hospitalized patients were included. 66.1% of the patients had an early clinical response. The mean length of hospital stay in patients with an early clinical response were each 4.3 d shorter than in patients without an early clinical response. In the multiple regression analysis, initial appropriate antibiotic therapy (OR = 2.449, P = 0.006), extended-spectrum p-lactamase (ESBL)-producing E. coli (OR = 2.112, P = 0.044), improper use of broad-spectrum antimicrobials (OR = 0.411, P = 0.006), and a stay in a healthcare facility before admission (OR = 0.562, P = 0.033) were the factors associated with an early clinical response. Initial broad-spectrum antibiotic therapy was not associated with an early clinical response. CONCLUSION ESBL producing E. coli, and the type of residence before hospital admission were the factors associated with an early clinical response. Appropriateness of initial antibiotic therapy was a predictive factor for an early clinical response, but broad-spectrum of initial antibiotic therapy did not impact early clinical response.