Aminoglycosides may serve as
fluoroquinolone-sparing or
cephalosporin-sparing agents if the clinical effectiveness of
aminoglycoside monotherapy is demonstrated. The purposes of this study were to investigate the clinical efficacy of
gentamicin as an initial empirical
antimicrobial agent and to evaluate the effects of
gentamicin resistance on clinical outcomes in women with complicated non-obstructive acute
pyelonephritis (APN). Medical records of 1066 women with a diagnosis of APN were reviewed retrospectively. We enrolled 275 women with community-onset complicated non-obstructive APN due to Enterobacteriaceae who received
gentamicin as their initial
antibiotic. Of these 275 patients, 43 had
gentamicin-resistant (GM-R) Enterobacteriaceae APN, and 232 had
gentamicin-susceptible (GM-S) Enterobacteriaceae APN. The early clinical success rates were 67.4% (29/43) versus 89.7% (208/232) at 72 h in the GM-R versus the GM-S groups (p 0.001). The overall clinical cure rate was 100% (43/43) and 98.7% (229/232) in the GM-R and GM-S groups, respectively. The duration of
hospital stay was significantly longer in the elderly, although there were no significant differences in the rates of early clinical success, final clinical cure, mortality, and time to
fever clearance between the elderly and non-elderly groups. Resistance of Enterobacteriaceae to
gentamicin, haematuria and serum
C-reactive protein level≥20 mg/dL were independently associated with early clinical failure.
Gentamicin can be an effective initial
antibiotic option for empirical
therapy in women with community-onset complicated APN who do not need urological interventional procedures. The use of
gentamicin may contribute to a reduction of
fluoroquinolone or broad-spectrum
cephalosporin use in the treatment of complicated APN.