The influence of chronic renal failure on the spectrum and antimicrobial susceptibility of uropathogens in community-acquired acute pyelonephritis presenting as a positive urine culture

We performed a retrospective analysis of 502 adults (54 men, 448 women; mean age 61.7 ± 16.0 years, range 18-98 years) who were treated for community-acquired APN at Kosin University Gospel Hospital (Busan, Republic of Korea) during a ten-year period (January 2000 to December 2009). We evaluated the spectra and antimicrobial susceptibility profiles of uropathogens in CRF and non-CRF patients with community-acquired APN that presented as a positive urine culture.The 502 adult subjects were classified as either non-CRF APN patients (336 patients, 66.9%) or CRF APN patients (166 patients, 33.1%) according to their estimated glomerular filtration rate. No significant differences in the sensitivity of E. coli to a third cephalosporin, aminoglycoside (except gentamycin), or ciprofloxacin were observed between non-CRF and CRF patients.In our series of patients with community-acquired APN that initially presented as a positive urine culture, CRF did not influence the isolation rates of different uropathogens or their patterns of susceptibility to antimicrobials.Acute pyelonephritis (APN), an infectious disease of the renal parenchyma and pelvic region, is a significant and frequent cause of morbidity, resulting in more than 100,000 hospital admissions per year in the United States [1,2]. The most common pathogens in APN belong to the Enterobacteriaceae family, and Escherichia coli is the causative pathogen in more than 80% of cases [1]. Other microbes contributing to the pathogenesis of APN include Proteus spp, Klebsiella spp, and enterococci [3]. Risk factors that predispose women to APN include diabetes mellitus (DM), incontinence, patient and family history of urinary tract infections (UTIs), and certain sexual behaviors [4]. Although DM is a risk factor, it was previously reported that DM does not influence the isolation rates of different uropathogens or their patterns of susceptibility to antimicrobials [5].In general, CRF patients are known to be vulnerable to infect