| Summary: | This study examined changes in the clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between the period 2010–2011 and 2017–2018. We recruited all CA-APN patients aged ≥19 years who visited eight hospitals in South Korea from September 2017 to August 2018, prospectively. Data collected were compared with those from the previous study in 2010–2012, with the same design and participation from 11 hospitals. A total of 617 patients were enrolled and compared to 818 patients’ data collected in 2010–2011. <i>Escherichia coli</i> was the most common causative pathogen of CA-APN in both periods (87.3% vs. 86.5%, <i>p</i> = 0.680). <i>E. coli</i> isolates showed significantly higher antimicrobial resistance against fluoroquinolone (32.0% vs. 21.6%, <i>p</i> < 0.001), cefotaxime (33.6% vs. 8.3%, <i>p</i> < 0.001), and trimethoprim/sulfamethoxazole (37.5% vs. 29.2%, <i>p</i> = 0.013) in 2017–2018 than in 2010–2011. Total duration of antibiotic treatment increased from 16.55 ± 9.68 days in 2010–2011 to 19.12 ± 9.90 days in 2017–2018 (<i>p</i> < 0.001); the duration of carbapenem usage increased from 0.59 ± 2.87 days in 2010–2011 to 1.79 ± 4.89 days in 2010–2011 (<i>p</i> < 0.001). The median hospitalization was higher for patients in 2017–2018 than in 2010–2011 (9 vs. 7 days, <i>p</i> < 0.001). In conclusion, antimicrobial resistance of <i>E. coli</i> to almost all antibiotic classes, especially third generation cephalosporin, increased significantly in CA-APN in South Korea. Consequently, total duration of antibiotic treatment, including carbapenem usage, increased.
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