Descriptive study of complicated pyelonephritis
Abstract number: p1853
Villalobos A., Plata A., Portales I., Macías N., Federico A., Santamaría S., López D., Uribarri G., Colmenero J.D.
To determine the clinical and epidemiological characteristics, etiological agents, and diagnosis of complicated or severe pyelonephritis.
A retrospective, descriptive study of a series of 634 patients with complicated or severe pyelonephritis that fulfilled the IDSA criteria and required hospital admission to the Intensive Care Unit or the Internal Medicine Ward of Carlos Haya Hospital, Malaga, from January 1996 to December 2004.
The study included 634 patients, with a mean age of 57.58 ± 19.2. 456 (71.9%) were women. The predisposing factors were: renal lithiasis patients (26.7%), prostatic adenoma (8.2%), vesical structure disease (4.3%), vesical functional disorder (6.6%), chronic kidney failure (4.3%). The underlying diseases included: diabetes mellitus (30.3%), immunosuppression (6.8%), previous urinary tract instrumentation (4.3%), permanent catheter (3.6%). The mean hospital stay was 10.93 ± 8.7 days. The mean duration of symptoms was 5.9 ± 8.2 days, among which were fever (89.1%), chills (79.3%), lumbar pain (77.3%), mictional syndrome (70.5%), flank tenderness (76.8%). Laboratory data included leukocytosis, leukocyturia (90.1%), bacteriuria (23.3%). Blood cultures were positive in 204 patients (41.2% of the blood cultures performed). Urine cultures were positive in 352 patients (59.6% of the urine cultures performed). The most frequent pathogens were: E. coli (72.9%), Proteus (7.1%), Klebsiella, Enterobacter, Serratia (5.4%) and Enterococcus (4.3%). Abdominal ultrasound was undertaken in 90.9% of the cases, with 46% showing disease. Of note among the complications were sepsis (25.7%), septic shock (8.4%), acute kidney failure (16.1%), and perinephritic abscess (1.6%). 29 patients (4.6%) died; attributable mortality (3.5%).
1) Complicated or severe upper urinary tract infection is a common cause of hospital admission in our setting. 2) The absence of leukocyturia or mictional syndrome does not exclude the presence of complicated upper UTI. 3) The high percentage of bacteriemia necessitates blood cultures, with E. coli being the most common pathogen. 4) The associated morbidity and mortality are important in association with sepsis or septic shock.
|Session name:||XXIst ISTH Congress|
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