Abstract
BackgroundEmphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. Percutaneous drainage is now the gold standard of definitive management. The aim of this study is to analyze the predictors associated with failure of conservative treatment among patients with EPN and offer the recommendation of appropriate empirical antibiotic regimen.MethodsFrom January 2001 to December 2013, 44 consecutive patients were diagnosed with EPN. The demographic characteristics, clinical presentations, management strategies, and final outcomes were analyzed retrospectively.ResultsThe overall survival rate was 88.6% (39/44). Need for emergency hemodialysis, shock on initial presentation, altered mental status, severe hypoalbuminemia, inappropriate empirical antibiotic treatment and polymicrobial infections were significantly more common in the patients who died compared with the survivors. The overall failure rate of conservative treatment was 32.6% (14/43). Severe hypoalbuminemia (p = 0.003), need for emergency hemodialysis (p = 0.03), and polymicrobial infections (p = 0.04) were significantly associated with failure of conservative treatment. Severe hypoalbuminemia was independently associated with conservative management failure (p = 0.02). Even in the patients treated with percutaneous drainage plus effective antibiotics, failure was still associated with severe hypoalbuminemia (p = 0.01). According to the in vitro susceptibility data, third-generation cephalosporins is recommended as the empirical antibiotic regimen.ConclusionsBoth appropriate empirical antibiotic and percutaneous drainage were essential for patients with EPN. Patients with severe hypoalbuminemia had a higher risk of conservative treatment failure, and additional management may be required.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-418) contains supplementary material, which is available to authorized users.
Highlights
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens
Until the late 1980s, the management of EPN usually involved emergency nephrectomy and/or open surgical drainage with antibiotic treatment [1], this approach was associated with a mortality rate of 40% to 50% [3]
The left kidney was more frequently affected than the right (28 vs. 18); 2 patient had bilateral involvement and 2 had EPN of a solitary kidney
Summary
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidneys that is characterized by bacterial production of gas within the renal parenchyma [1]. It occurs most commonly in female diabetic patients (70% to 90%), and has a mortality rate of up to 80% when patients are only treated medically [1,2]. Until the late 1980s, the management of EPN usually involved emergency nephrectomy and/or open surgical drainage with antibiotic treatment [1], this approach was associated with a mortality rate of 40% to 50% [3]. Over the last two decades, improvements in management techniques have resulted in a decrease in the mortality rate to 21% [5]
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