The objectives of this study were to evaluate the clinical effectiveness of
gentamicin as an initial empirical
antimicrobial agent and to determine the effects of
gentamicin resistance on clinical outcomes in women with uncomplicated acute
pyelonephritis (APN). We analyzed data of 2,033 women with a diagnosis of APN admitted to Catholic University St. Vincent's Hospital. Of those, we enrolled 274 cases of community-acquired uncomplicated APN due to Escherichia coli who received
gentamicin as initial
antibiotics. Of these 274 patients, 47 patients had
gentamicin-resistant (GM-R) E. coli APN, and 227 patients had
gentamicin-susceptible (GM-S) E. coli APN. The early clinical response rates were 55.3% (26/47) versus 81.5% (185/227) at 72 hours; 61.7% (29/47) versus 96.9% (220/227) at 96 hours in the GM-R and GM-S groups, which was significantly higher in the GM-S group (p<0.001). Overall clinical cure rates were 100% (47/47) and 99.6% (226/227) in the GM-R and GM-S groups, respectively. APN patients in the GM-R group had longer hospitalization (9.72 ± 3.46 and 7.89 ± 2.27 days; p<0.001) than those in the GM-S group. Resistance of E. coli to
gentamicin,
bacteremia, and
C-reactive protein level showed independent effects on early clinical failure.
Aminoglycoside such as
gentamicin can be an alternative
antibiotic option for initial empirical
therapy of community-acquired uncomplicated APN as the
fluoroquinolone-sparing or broad-spectrum
cephalosporin-sparing agents in an era of increasing antimicrobial resistance, especially in areas where medical resources are limited or antibiotic resistance rate of the uropathogens is high.