A comparative study of acute nonemphysematous pyelonephritis in diabetics and nondiabetics from a tertiary care hospital in South India

Abstract

AIM: The aim of this study is to analyze the clinical, biochemical, and microbiological characteristics of patients with acute nonemphysematous pyelonephritis in diabetics and nondiabetics from Indian subcontinent. MATERIALS AND METHODS: It is a retrospective study conducted at a tertiary care hospital from January 2012 to August 2016. The hospital medical records were searched electronically for clinical, biochemical, and microbiologic data. RESULTS: A total of 177 patients were enrolled for the study. in the diabetic group (51.9 years) was slightly higher than the nondiabetic patients (45.7 years). Nondiabetic patients presented late when compared to diabetics (6.38 days against 4.7 days). About 11.5% in diabetics against 5.8% in nondiabetics had recurrent urinary tract infection. The urine culture in the diabetics and nondiabetics showed positive growth in 43.8% and 43.2% of cases, respectively, with Escherichia coli, extended-spectrum β-lactamase, and Klebsiella being commonly identified organisms. Blood culture specimens in both the groups had high negative results with 86.5% in diabetics and 98.8% in nondiabetics. Over 90% of patients in either group responded to treatment with either antibiotic alone or in combination with double-J stenting. Temporary hemodialysis was required in 8% in diabetic group and 6% in nondiabetic group. Maintenance hemodialysis was required in approximately 3% of diabetic patients. CONCLUSION: In our study, the incidence of acute pyelonephritis was found to be higher in patients in their fifth decade of life. Diabetics had more severe infection at presentation and consequently had poorer outcomes in terms of residual renal function and need for dialysis.