Cefuroxime Resistance in Pyelonephritis
Cefuroxime Resistance in Pyelonephritis
Resistance to empirical antibiotic treatment has resulted in increased mortality and
 morbidity in serious infections caused by certain common resistant pathogens in the
 community. The risk for increased mortality has been also the motivation for recent
 guidelines that suggest early empirical antimicrobial treatment with broad spectrum
 antibiotics within a few hours of suspecting sepsis, regardless of the potential
 microorganism or infection focus. Resistance to second-generation cephalosporins among
 patients with community-acquired urinary tract infection by E. coli has exceeded 20% in an
 increasing number of institutions and communities, without being clear about the impact of
 such resistance on the effectiveness of treatment. This is especially important in urinary
 infections, since, in general, mortality is very low. We expect to establish if there is a
 relationship between inappropriate empirical therapy and morbidity (in terms of length of
 stay or readmission) among hospitalized patients with pyelonephritis treated with empirical
 cefuroxime therapy to help to define the need for a change in the current guidelines. These
 guidelines will have application not only in Colombia, but also in other countries in Latin
 America or other countries that still use this empirical therapy. It will also define the
 need for use of broader spectrum antibiotics in this clinical scenario.
Objectives:

 1. Establish the relationship between inappropriate empirical cefuroxime therapy in adult
 patients hospitalized with pyelonephritis and hospital stay.

 2. Establish the relationship between inappropriate empirical cefuroxime therapy in adult
 patients hospitalized with pyelonephritis and readmission due to pyelonephritis.

 3. Establish the relationship between inappropriate empirical therapy with cefuroxime in
 adult patients hospitalized with pyelonephritis and the time to readmission caused
 pyelonephritis.

 The investigators proposed a retrospective cohort of hospitalized pyelonephritis patients
 with empirical antimicrobial management with cefuroxime in one institution of third
 complexity level. Exposure is understood as resistance to cefuroxime, that is, the impact of
 inappropriate empirical cefuroxime therapy on patients receiving this antibiotic. Patients
 who are admitted to the cohort had the diagnosis of pyelonephritis and were hospitalized for
 intravenous antimicrobial treatment and are followed up to the following outcomes: hospital
 discharge, or readmission due to pyelonephritis to the same or another institution of the
 insurance network.

 The study will be conducted following the Good Clinical Practices for Research and approval
 by the Research Ethics Committee (REC) or Investigation Research Boards (IRB) of the
 participating institutions. The clinical information will be collected through online forms
 based on the information in the electronic medical record. Microbiological information will
 be taken from clinical laboratory reports (Whonet ver 5.5., WHO). The accuracy of the
 information collected will be verified by evaluating 100% of the formats. A pilot test will
 be carried out after approval by the IRB (25 february, 2020). The information will be stored
 anonymously, discarding from the database personal information of the patient that might
 allow the identification. Variables collected from the Electronic Medical Record include
 demographic, clinical (comorbidities, clinical status) and microbiological information. Other
 variables include time to change antibiotic (if done) and time of use of antibiotic.
 Information for the outcomes proposed include length of stay (in days), readmission (new
 admission because of pyelonephritis in the following 30 days after the first episode), and
 time to readmission (in days).

 A propensity score matching will be performed to diminish the risk of selection bias and
 unbalanced subjects. Alternatively, and inverse probability treatment weighting can be used
 to balance the variables included. Both models will be constructed using a logistic
 regression for the probability of cefuroxime resistant. Final comparison between the exposed
 population and control population will be done using survival curves for the time to hospital
 discharge.
Inclusion Criteria:

 -  Age ≥ 18 years.

 -  Clinical diagnosis of pyelonephritis.

 -  Antibiotic treatment with cefuroxime.

 -  Urine culture positive for Escherichia coli

 Exclusion Criteria:

 -  Use of antibiotic for less than 24 hours.

 -  Not availability of antimicrobial susceptibility testing.

 -  Use of urinary catheter for more than 30 days.