Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Descriptive Epidemiology of Acute Pyelonephritis in Korea, 2010-2014: Population-based Study

  • Kim, Bongyoung (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Myung, Rangmi (Department of Economics, College of Political Science and Economics, Korea University) ;
  • Kim, Jieun (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Lee, Myoung-jae (Department of Economics, College of Political Science and Economics, Korea University) ;
  • Pai, Hyunjoo (Department of Internal Medicine, College of Medicine, Hanyang University)
  • Received : 2018.02.20
  • Accepted : 2018.07.12
  • Published : 2018.12.03
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Abstract

Background: Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. Methods: From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. Results: The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). Conclusion: The epidemiology of APN in Korea has been changing with an increasing incidence rate.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007;45(3):273-80. https://doi.org/10.1086/519268
  2. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies. Am J Med 2002;113 Suppl 1A:35S-44S. https://doi.org/10.1016/S0002-9343(02)01058-6
  3. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol 2010;7(12):653-60. https://doi.org/10.1038/nrurol.2010.190
  4. Kim B, Kim J, Seo MR, Wie SH, Cho YK, Lim SK, et al. Clinical characteristics of community-acquired acute pyelonephritis caused by ESBL-producing pathogens in South Korea. Infection 2013;41(3):603-12. https://doi.org/10.1007/s15010-013-0441-z
  5. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008;8(3):159-66. https://doi.org/10.1016/S1473-3099(08)70041-0
  6. Bou-Antoun S, Davies J, Guy R, Johnson AP, Sheridan EA, Hope RJ. Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014. Euro Surveill 2016;21(35):30329. https://doi.org/10.2807/1560-7917.ES.2016.21.35.30329
  7. Wie SH, Ki M, Kim J, Cho YK, Lim SK, Lee JS, et al. Clinical characteristics predicting early clinical failure after 72 h of antibiotic treatment in women with community-onset acute pyelonephritis: a prospective multicentre study. Clin Microbiol Infect 2014;20(10):O721-9. https://doi.org/10.1111/1469-0691.12500
  8. Kim JA, Yoon S, Kim LY, Kim DS. Towards actualizing the value potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data. J Korean Med Sci 2017;32(5):718-28. https://doi.org/10.3346/jkms.2017.32.5.718
  9. Ki M, Park T, Choi B, Foxman B. The epidemiology of acute pyelonephritis in South Korea, 1997-1999. Am J Epidemiol 2004;160(10):985-93. https://doi.org/10.1093/aje/kwh308
  10. Statistics Korea. Annual estimated population. http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=M#SubCont/. Updated 2016. Accessed September 20, 2016.
  11. Day MJ, Doumith M, Abernethy J, Hope R, Reynolds R, Wain J, et al. Population structure of Escherichia coli causing bacteraemia in the UK and Ireland between 2001 and 2010. J Antimicrob Chemother 2016;71(8):2139-42. https://doi.org/10.1093/jac/dkw145
  12. Nicolas-Chanoine MH, Bertrand X, Madec JY. Escherichia coli ST131, an intriguing clonal group. Clin Microbiol Rev 2014;27(3):543-74. https://doi.org/10.1128/CMR.00125-13
  13. Johnson JR, Porter S, Thuras P, Castanheira M. The pandemic H30 subclone of sequence type 131 (ST131) as the leading cause of multidrug-resistant Escherichia coli infections in the United States (2011-2012). Open Forum Infect Dis 2017;4(2):ofx089.
  14. Robey RC, Drysdale SB, Kelly DF, Bowler IC, Sadarangani M. Age-specific trends in antibiotic resistance in Escherichia coli infections in Oxford, United Kingdom 2013-2014. J Infect 2017;74(2):195-8. https://doi.org/10.1016/j.jinf.2016.10.006
  15. Kim YA, Kim JJ, Kim H, Lee K. Community-onset extended-spectrum-$\beta$-lactamase-producing Escherichia coli sequence type 131 at two Korean community hospitals: the spread of multidrug-resistant E. coli to the community via healthcare facilities. Int J Infect Dis 2017;54:39-42. https://doi.org/10.1016/j.ijid.2016.11.010
  16. Kang CI, Cha MK, Kim SH, Ko KS, Wi YM, Chung DR, et al. Clinical and molecular epidemiology of community-onset bacteremia caused by extended-spectrum $\beta$-lactamase-producing Escherichia coli over a 6-year period. J Korean Med Sci 2013;28(7):998-1004. https://doi.org/10.3346/jkms.2013.28.7.998
  17. Statistics Korea. Microdata integrated service. https://mdis.kostat.go.kr/index.do/. Updated 2018. Accessed June 16, 2018.
  18. Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents 2001;17(4):259-68. https://doi.org/10.1016/S0924-8579(00)00350-2
  19. Johnson JR. Microbial virulence determinants and the pathogenesis of urinary tract infection. Infect Dis Clin North Am 2003;17(2):261-78. https://doi.org/10.1016/S0891-5520(03)00027-8
  20. Nicolle LE, Friesen D, Harding GK, Roos LL. Hospitalization for acute pyelonephritis in Manitoba, Canada, during the period from 1989 to 1992; impact of diabetes, pregnancy, and aboriginal origin. Clin Infect Dis 1996;22(6):1051-6. https://doi.org/10.1093/clinids/22.6.1051
  21. Kim Y, Seo MR, Kim SJ, Kim J, Wie SH, Cho YK, et al. Usefulness of blood cultures and radiologic imaging studies in the management of patients with community-acquired acute pyelonephritis. Infect Chemother 2017;49(1):22-30. https://doi.org/10.3947/ic.2017.49.1.22
  22. Agency for Healthcare Research and Quality (AHRQ). American College of Radiology appropriateness $criteria^{(R)}$ acute pyelonephritis. http://www.guideline.gov/content.aspx?id=37923. Updated 2016. Accessed August 11, 2016.
  23. Soulen MC, Fishman EK, Goldman SM, Gatewood OM. Bacterial renal infection: role of CT. Radiology 1989;171(3):703-7. https://doi.org/10.1148/radiology.171.3.2655002
  24. Organization for Economic Co-operation and Development (OECD). Health at a glance 2015: OECD indicators. http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2015_health_glance-2015-en#.WBHO6tKLRpg#page1/. Updated 2015. Accessed 27 October 2016.
  25. Smith-Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 2008;27(6):1491-502. https://doi.org/10.1377/hlthaff.27.6.1491
  26. Camberlin C, Ramaekers D. Measuring appropriate use of antibiotics in pyelonephritis in Belgian hospitals. Comput Methods Programs Biomed 2009;94(2):143-51. https://doi.org/10.1016/j.cmpb.2008.12.002

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