Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study

Abstract

BackgroundComplicated pyelonephritis (cPN), a common cause of hospital admission, is still a poorly-understood entity given the difficulty involved in its correct definition. The aim of this study was to analyze the main epidemiological, clinical, and microbiological characteristics of cPN and its prognosis in a large cohort of patients with cPN.MethodsWe conducted a prospective, observational study including 1325 consecutive patients older than 14 years diagnosed with cPN and admitted to a tertiary university hospital between 1997–2013. After analyzing the main demographic, clinical and microbiological data, covariates found to be associated with attributable mortality in univariate analysis were included in a multivariate logistic regression model.ResultsOf the 1325 patients, 689 (52%) were men and 636 (48%) women; median age 63 years, interquartile range [IQR] (46.5-73). Nine hundred and forty patients (70.9%) had functional or structural abnormalities in the urinary tract, 215 (16.2%) were immunocompromised, 152 (11.5%) had undergone a previous urinary tract instrumentation, and 196 (14.8%) had a long-term bladder catheter, nephrostomy tube or ureteral catheter. Urine culture was positive in 813 (67.7%) of the 1251 patients in whom it was done, and in the 1032 patients who had a blood culture, 366 (34%) had bacteraemia. Escherichia coli was the causative agent in 615 episodes (67%), Klebsiella spp in 73 (7.9%) and Proteus ssp in 61 (6.6%). Fourteen point one percent of GNB isolates were ESBL producers. In total, 343 patients (25.9%) developed severe sepsis and 165 (12.5%) septic shock. Crude mortality was 6.5% and attributable mortality was 4.1%. Multivariate analysis showed that an age >75 years (OR 2.77; 95% CI, 1.35-5.68), immunosuppression (OR 3.14; 95% CI, 1.47-6.70), and septic shock (OR 58.49; 95% CI, 26.6-128.5) were independently associated with attributable mortality.ConclusionscPN generates a high morbidity and mortality and likely a great consumption of healthcare resources. This study highlights the factors directly associated with mortality, though further studies are needed in the near future aimed at identifying subgroups of low-risk patients susceptible to outpatient management.

Autotransporter proteins of Uropathogenic Escherichia coli: regulation, characterisation and the role of periplasmic proteins in their expression

“…~20Å), has been noted (Noinaj et al, 2013b). Additionally, the outer membrane layer in proximity to this lateral gate was found to be decreased in phospholipid order and overall thickness, a result consistent with other studies (Gessmann et al, 2014, Sinnige et al, 2014, Burgess et al, 2008. This lateral gate is also structurally conserved within the crystal structure of the TamA protein (Gruss et al, 2013a).…”

“…Risk factors such as physical/functional genitourinary tract abnormalities, catheterization, diabetes, neurological disorders, pregnancy or supressed immunity can predispose patients to chronic UTI (Haider et al, 2010, Turner et al, 2015, Storm et al, 2012, Buonaiuto et al, 2014, De Ruz et al, 2000, Nicolle et al, 1996, Carton, 1992, Kunin et al, 1992. In the nosocomial environemt, catheter-associated UTI (CAUTI) is very common (Al-Hazmi, 2015, Apisarnthanarak et al, 2007.…”

Management of acute pyelonephritis in the emergency department observation unit

“…The percentage of patients with negative urine cultures in other studies range from 3.6% to 32.3% depending on the inclusion and exclusion criteria of each study. (7,11) The high percentage of negative urine cultures found could be due to 109 (23.7%) patients having received outpatient antibiotics before the ED visit, although the details of the type of antibiotics and duration of treatment were often unspecified. Another reason could be the commencement of empirical antibiotics in the ED after obtaining blood cultures, with a delay in obtaining urine cultures, particularly for patients who appeared ill. A previous study had shown that negative urine cultures can coexist with imaging-proven pyelonephritis.…”

“…The reviewers were not blinded to the purpose of the study. Patients with at least two out of the following three inclusion criteria (11) were recruited into the study: (a) flank pain or costovertebral angle tenderness; (b) urinary symptoms or bacteriuria/pyuria; and (c) fever. Subjects were also included if they were labelled as having pyelonephritis based on imaging (ultrasonography of the kidneys or computed tomography of the kidneys, ureters and bladder) or by the managing team.…”

Escherichia hermannii - An Unusual Pathogen Causing Urinary Tract Infection

“…The most common organism responsible that is reported to cause pyelonephritis is Escherichia coli followed by Proteus spp, Klebsiella spp etc. [3]. Catheterization, congenital anomalies, immunosuppression therapy, post-transplant status, renal stones, diabetes mellitus are the major risk factors for UTI amongst which diabetes mellitus ranks highest in most of the studies.…”