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

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 β-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.