Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series

Abstract

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. Methods: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. Results: A total of 570 patients were included. Median (IQR) age was 57 (47–65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081–2.413, p = 0.019), and Huang–Tseng type 4 (OR 1.948 95% CI 1.005–3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang–Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081–2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). Conclusions: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes

“…A study from Mexico reported that the rate of ESBL-producing microorganisms in EPN was 31.7% ( 20 ). Another study from a large, multicenter series shown that 52.3% of urine cultures were positive for ESBL agents in EPN ( 30 ). It pointed out that the most common antibiotics associated with ESBL agents are prior use of third-generation cephalosporins and quinolones.…”

Clinical Presentation, Microbiological Characteristics, and Their Implications for Perioperative Outcomes in Xanthogranulomatous Pyelonephritis: Perspectives from a Real-World Multicenter Practice

“…A possible diagnosis of XGP or emphysematous pyelonephritis must be considered in immunocompromised patients, especially whenever clinical presentation is atypical, current antibiotic therapy is not effective, and imaging shows features of dubious interpretation, since these patients have a very high risk of morbidity and mortality [ 19 , 20 ]. 71% of our patients had a history of CKD and diabetes was present in 28.5% of them.…”

Prevalence and genetic characterization of clinically relevant extended-spectrum β-lactamase-producing Enterobacterales in the Gulf Cooperation Council countries

“…among Klebsiella isolates across diverse clinical sample types is similar to the range shown by general mixed samples, with prevalence rates of 10%-100% in blood samples, 5.5% among respiratory K. pneumoniae infections (ICU patients), 17.1% among MDR K. pneumoniae in endotracheal samples, 30% among emphysematous pyelonephritiscausing K. pneumoniae, and 25% and 34.3% among total K. pneumoniae/spp. in the case of surgical site and device-associated healthcare infections, respectively (Supplementary Table 2) (Balkhy et al, 2020;Bandy and Almaeen, 2020;El-Saed et al, 2020;Kabrah et al, 2021;Sannathimmappa et al, 2021;Bazaid et al, 2022;Robles-Torres et al, 2022).…”