Diagnosis Of Pyelonephritis Research Articles

Antenatal pyelonephritis hospitalisation trends, risk factors and associated adverse outcomes: A retrospective cohort study.

To analyse trends, risk factors and adverse outcomes associated with antenatal pyelonephritis hospitalisations. Retrospective cohort. A national sample of US delivery hospitalisations with associated antenatal hospitalisations. US delivery hospitalisations in the Nationwide Readmissions Database from 2010 to 2020. Antenatal hospitalisations with a pyelonephritis diagnosis within the 9 months before delivery hospitalisation were analysed. Clinical, demographic and hospital risk factors associated with antenatal pyelonephritis hospitalisations were analysed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios as measures of effect. Temporal trends in antenatal pyelonephritis hospitalisations were analysed with Joinpoint regression to determine the relative measure of average annual percent change (AAPC). Risk for severe maternal morbidity and sepsis during antenatal pyelonephritis hospitalisations was similarly analysed with Joinpoint regression. Of an estimated 10.2 million delivery hospitalisations, 49 140 (0.48%) had an associated antenatal pyelonephritis hospitalisation. The proportion of deliveries with a preceding antenatal pyelonephritis hospitalisation decreased by 29% from 0.56% in 2010 to 0.40% in 2020 (AAPC -2.9%, 95% CI -4.0% to -1.9%). Antenatal pyelonephritis decreased, but risk for sepsis diagnoses increased during these hospitalisations from 3.7% in 2010 to 18.0% in 2020 (AAPC 17.2%, 95% CI 14.2%-21.1%). Similarly, risk for severe morbidity increased from 2.6% in 2010 to 4.4% in 2020 (AAPC 5.5%, 95% CI 0.8%-10.7%). Antenatal pyelonephritis admissions appear to be decreasing in the USA. However, these hospitalisations are associated with a rising risk for sepsis and severe maternal morbidity.

#555 Acute graft pyelonephritis in a kidney transplant recipient—a single centre experience in northern India

Abstract Background and Aims Urinary tract infections (UTI) are the most common infections after kidney transplantation. Although clinical spectrum of pyelonephritis after kidney transplantation remain less clear. This study was conducted to evaluate the prevalence, clinical and microbiological profile with antibiogram of post-transplant pyelonephritis. Method We retrospectively reviewed and analysed the charts of 1684 patients, who underwent kidney transplantation at Medanta—The Medicity between January 2015 and May 2023. Patients were screened for the diagnosis of pyelonephritis and their clinical characteristics and outcome were evaluated. Results 93/1684 (5.5%) patients with a mean age of 41 ± 13.57 years had developed at least one episode of Pyelonephritis. 68 were males and 25 females. Older age, female gender, hyperglycaemia, use of induction immunosuppression were the risk factors for Pyelonephritis. Median time of occurrence was 44 days after transplantation. Most common symptoms were fever (n=64) followed by dysuria (n=40), and abdominal pain (n=11). Most common organism isolated was Escherichia coli (51.6%) followed by Klebsiella pneumonia (30.1%), and Pseudomonas aeruginosa (11.8%). This study showed a high percentage of resistance to commonly used antibiotics like Carbapenems (61.3%), third generation cephalosporin (49.5%). 41/93 (44%) patients had acute graft dysfunction at the time of presentation. Median duration of hospital stay was 7 days. 90/93 patients had graft recovery and one patient lost his graft after episode of UTI. Conclusion Pyelonephritis is a common cause of morbidity after kidney transplantation and occurs in an early post-transplant period. Gram negative bacilli are the major pathogens and carbapenems as an empirical therapy might be useful choice for management of Pyelonephritis and coverage of majority pathogens.

Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation.

The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. A cohort of 125 cats (149 observations). This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.

Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement.

Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing. To characterize treatment of pyelonephritis in a nationally representative sample of ED patients and to identify patient- and treatment-specific factors associated with receiving initial inactive antibiotics. We conducted a multicentre, observational cohort study utilizing the Emergency Medicine PHARMacotherapy Research NETwork (EMPHARM-NET), comprising 15 geographically diverse US EDs. All patients ≥18 years of age with a diagnosis of pyelonephritis between 2018 and 2020 were included. The primary endpoint was the proportion of patients who received initial inactive empirical antibiotic therapy and to identify predictive factors of inactive antibiotic therapy. Of the 3714 patients evaluated, 223 had culture-positive pyelonephritis. Median patient age was 50.1 years and patients were mostly female (78.3%). Overall, 40.4% of patients received an IV antibiotic, most commonly ceftriaxone (86.7%). The most frequently prescribed antibiotics were cefalexin (31.8%), ciprofloxacin (14.3%), cefdinir (13.5%) and trimethoprim/sulfamethoxazole (12.6%). Overall, 10.3% of patients received initial inactive therapy. After adjustment in a multivariable analysis, long-acting IV antibiotic was predictive of inactive therapy (OR 0.23, 95% CI 0.07-0.83). In our prospective, multicentre observational study, we found that only 40.4% of patients with pyelonephritis received empirical IV antibiotics in the ED, contributing to inactive therapy. Receipt of long-acting IV antibiotics was independently associated with a decreased rate of initial inactive therapy. This reinforces guideline recommendations to administer long-acting IV antibiotics empirically in the ED upon suspicion of pyelonephritis.

Bacterial Agents and Antibiotic Resistance Profile in Pyelonephritis; A Comparison between Children with and without Urinary Tract Abnormalities in the North of Iran

Background: Pyelonephritis in children is a serious condition that is commonly encountered in clinical practice. Urinary tract abnormalities increase the risk of urinary tract infections (UTIs) and consequently antibiotic resistance. Our study aimed to evaluate the local trend in terms of bacterial uropathogen resistance in Babol, Iran, in children with pyelonephritis considering urinary tract abnormalities. Methods: We recruited pediatric cases aged 1 month to 18 years who were admitted to Amirkola hospital with a diagnosis of pyelonephritis from 2016 to 2019. Children with negative urine cultures or incomplete imaging were excluded from the study. Causative agents were identified based on biochemical features. Antimicrobial in vitro resistance tests were performed using the disk diffusion agar test. Results: A total of 105 children were included in the study. E. coli was the most common causative agent found in 93 (88.6%) patients. Most of the bacterial isolates were sensitive to amikacin and imipenem, and only 12.4% and 13.3% of isolates were resistant to this antibiotic. On the other hand, nalidixic acid represented the least effective treatment, with a resistance rate of 88.6%. A statistically significant difference was observed in resistance to nitrofurantoin and nalidixic acid between children with and without anomalies (p &lt; 0.05). Conclusion: High antibiotic resistance, especially in children with urinary tract anomalies, was identified for frequently used antibiotics. Our findings provide important implications regarding local patterns of uropathogens and antibiotic resistance in children with pyelonephritis.

Utility of urinary presepsin in the diagnosis of pyelonephritis: a cross-sectional study

BackgroundPresepsin is produced during the phagocytosis of bacteria by granulocytes. Presepsin increases at the site of infection; however, the significance of urinary presepsin in pyelonephritis is unknown. This study aimed to evaluate whether measuring urinary presepsin can distinguish between pyelonephritis and nonpyelonephritis.MethodsA cross-sectional study of patients with suspected pyelonephritis was conducted. Urinary presepsin at admission was compared between the pyelonephritis and nonpyelonephritis groups using the Mann–Whitney test. The predictive accuracy of urinary presepsin for diagnosing pyelonephritis was evaluated by the area under the receiver operating characteristics (ROC) analysis curve.ResultsA total of 35 eligible participants were included in the pyelonephritis group and 25 in the nonpyelonephritis group. The median urinary presepsin level was 2232.0 (interquartile range [IQR], 1029.0–3907.0) pg/mL in the pyelonephritis group and 1348.0 (IQR, 614.5–2304.8) pg/mL in the nonpyelonephritis group. Urinary presepsin concentrations were significantly higher in the pyelonephritis group than in the nonpyelonephritis group (P = 0.023). ROC analysis of urinary presepsin revealed a cutoff value of 3650 pg/mL to distinguish between the pyelonephritis and nonpyelonephritis groups. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for the diagnosis of pyelonephritis were 0.40 (95% confidence interval [CI], 0.24–0.58), 0.96 (95% CI, 0.79–1.00), 0.93 (95% CI, 0.68–1.00), 0.52 (95% CI, 0.37–0.68), 9.60 (95% CI, 1.35–68.23), and 0.62 (95% CI, 0.47–0.83), respectively.ConclusionsThe measurement of urinary presepsin is useful in differentiating pyelonephritis from other diseases.

Urine neutrophil gelatinase-associated lipocalin as a biomarker of adult pyelonephritis

BackgroundPyelonephritis is a common infection at any age. Urine neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker of acute renal failure, is related to pyelonephritis in pediatric patients, although the significance of this urine biomarker in adult patients are not clear. We investigated the relationship between urine NGAL of pyelonephritis and non-pyelonephritis. Patients and methodsWe prospectively enrolled adult patients who were hospitalized due to pyelonephritis or non-pyelonephritis. Pyelonephritis was diagnosed in patients with fever and bacteriuria, with no any other infection focuses. Non-pyelonephritis was diagnosed in patients who had fever and another infection focus without bacteriuria. Urine samples were collected on days 0, 3 and 7. Urine NGAL levels were measured by ELISA. ResultsThere were 35 patients in the pyelonephritis group and 19 patients in the non-pyelonephritis group. Urine NGAL level were significantly higher in the pyelonephritis group than the non-pyelonephritis group on day 0 (median 302 ng/mL vs 25 ng/mL, p = 0.006). The area under the receiver operating characteristic curve of NGAL was 0.78 (p = 0.006). Urine NGAL level had a specificity of 66.7% and sensitivity of 87.0% at the cut-off level of 250 ng/mL for diagnosing pyelonephritis. ConclusionsUrine NGAL level at the diagnosis of infection are elevated in adult patients with pyelonephritis, but not in those with non-pyelonephritis. Urine NGAL might be a supportive biomarker for the diagnosis of pyelonephritis.

2239. Evaluating the Use of Cefuroxime for the Treatment of Outpatient Pyelonephritis at an Indian Health Service Hospital

Abstract Background In 2015, a rural Indian Health Service Hospital found itself unable to use SMX/TMP due to high E. coli resistance rates. The stewardship team decided to include cefuroxime as a first line agent for outpatient pyelonephritis to have a fluoroquinolone sparing agent. Oral B-lactams are not typically recommended over SMX/TMP or fluoroquinolones for pyelonephritis, however there is sparse literature on the use of cefuroxime. This retrospective review aims to evaluate the efficacy of cefuroxime therapy for acute uncomplicated pyelonephritis over a five-year period. Methods 528 patients with a diagnosis of pyelonephritis from January 1st, 2015 to December 31st, 2019 were screened. Data collection included 30-day reinfection rates, emergence of ESBL isolates, duration of therapy, one time IV antibiotic administration, urine culture and susceptibility, increased risk (genitourinary abnormalities and diabetes), white blood cell count, and symptoms. Pediatric patients and patients requiring hospital admission were excluded. Results 264 patients were included and 188 patients received cefuroxime therapy. Baseline characteristics included 94.5% female patients, median age of 44 years, and average duration of therapy of 11.6 days. 95% of the isolates were E. coli. 31 patients had treatment failure defined as a return to the ED with 30 days for UTI. 25 of those patients received cefuroxime and of those, 20 had a one-time IV antibiotic dose. 10 patients with treatment failure had a history of ESBL after the encounter and of those 3 patients had cefuroxime therapy. 5 patients who had treatment failure with cefuroxime had diabetes and genitourinary abnormality. Conclusion This review suggests a lower rate of bacteriological cure of acute uncomplicated pyelonephritis with cefuroxime therapy with or without a one-time IV antibiotic dose with a cephalosporin or aminoglycoside. Disclosures All Authors: No reported disclosures.

Post mortem computed tomography is highly sensitive for pyelonephritis. A radiologic-pathologic correlation series.

Pyelonephritis is a potentially lethal disease occasionally encountered in the forensic setting. Post mortem computed tomography (PMCT) is an important investigative tool for the forensic pathologist. In particular, it may be used to document and screen disease prior to traditional autopsy methods. While the sensitivity and specificity of computed tomography for pyelonephritis is well studied in the antemortem clinical setting, the test characteristics of PMCT are not yet described in the forensic pathology literature. A series of all cases of fatal pyelonephritis identified at the Ontario Forensic Pathology Service, over the course of 1year was studied. Radiologic, clinical and pathologic findings were reviewed. A fulsome autopsy, including histopathologic examination, was considered the gold standard for sensitivity and specificity calculations. A control group consisting of 16 cases without pyelonephritis (ex: opiate toxicity) in which both PMCT and histologic data were available by way of comparison. Sixteen cases of pyelonephritis were identified. Post mortem computed tomographical signs of pyelonephritis included asymmetric renal enlargement, perinephric fat stranding, and ectopic renal air. The most (57%) individually sensitive of these findings was perinephric fat stranding but sensitivity increased to 100% if any of the three signs were present. The control group analysis revealed the specificity of air asymmetry (81%), asymmetric renal enlargement (81%), and fat stranding (69%). PMCT findings may rule in a diagnosis of pyelonephritis, and should prompt the pathologist to grossly and microscopically examine the kidneys.

Pielonefritis

Pyelonephritis is a type of urinary tract infection (UTI) that generally begins in the urethra or bladder and spreads to one or both kidneys. In the United States, the incidence of acute pyelonephritis is 250,000 visits and 200,000 hospitalizations annually. The clinical manifestations of acute pyelonephritis consist of fever (&gt; 38°C), chills, low back pain, and pain. Patients with complicated acute pyelonephritis may have sepsis and acute kidney diseases (AKI). 1,2,4 To establish the diagnosis of pyelonephritis requires laboratory examination and radiological imaging, such as ultrasound, whether or not using contrast. Once diagnosed, pyelonephritis should be treated promptly, initially with empiric antimicrobial therapy and then continued according to the bacteria detected in the urine

Facklamia hominis pyelonephritis in a pediatric patient: first case report and review of the literature

BackgroundPyelonephritis is one of the most serious bacterial illnesses during childhood. Gram-negative organisms account for up to 90% of the cases. Gram-positive bacteria are uncommon causes of urinary tract infections, and only a few cases caused by Facklamia hominis have been reported in the literature.Case presentationA five-year-old girl with tracheostomy and gastrostomy and past medical history of congenital lymphangioma presented with a two-week history of with intermittent fever, frequent urination, and vesical tenesmus. Diagnosis of pyelonephritis was made. Urine culture reported colonies with alpha-hemolysis in blood agar at 48-h of incubation and Facklamia hominis was identified by MALDI-TOF. The patient was successfully treated with gentamicin.ConclusionsThis is the first reported case of pyelonephritis by Facklamia hominis in a child, and the second involving infection in a pediatric patient. Although this pathogen is uncommon, current treatment of F. hominis is a challenge for physicians. This case illustrates the requirement to standardize identification and treatment of care to avoid treatment failure and antimicrobial resistance.

«In the post period of covid -19 diseasespecific clinical-laboratory properties and diagnosis of pyelonephritis in children»

«In the post period of covid -19 diseasespecific clinical-laboratory properties and diagnosis of pyelonephritis in children»

Postpartum Pyelonephritis and Risk of Severe Maternal Morbidity.

Pyelonephritis is the most common nonobstetric cause for hospitalization during pregnancy. The maternal and obstetric complications associated with antepartum pyelonephritis are well described. However, it is not clear whether these risks extend into the postpartum period. The primary objective of this study was to describe the morbidity associated with postpartum pyelonephritis, by comparing the morbidity associated with pyelonephritis in the postpartum period to morbidity seen during pregnancy or delivery. A retrospective cohort study was performed using the Nationwide Readmissions Database (NRD), an all-payor sample of discharges from approximately 60% of U.S. hospitalizations. Discharges between October 2015 and December 2018 were included. Maternity-associated hospitalizations, diagnosis of pyelonephritis, comorbid conditions, and incidence of severe maternal morbidity were identified using International Classification of Disease-10th Revision (ICD-10) diagnosis and procedure codes. Bivariate statistics, weighted to account for the complex survey methods in the NRD, were used to evaluate the association between antepartum, delivery, and postpartum hospital stays associated with pyelonephritis and maternal morbidity. Weighted regression models were used to evaluate the association between admission timing and maternal outcomes. A total of 32,850 pyelonephritis admissions were identified, corresponding to a national estimate of 61,837 admissions. Of these, 1,465 (2.4%) were postpartum, 55,056 (89.0%) were antepartum, and 5,317 (8.6%) involved a delivery stay. Rates of severe maternal morbidity were higher in the postpartum group than the antepartum or delivery hospitalization groups (59.5 vs. 12.9 and 15.8%, respectively, p < 0.001); when compared with antepartum hospitalizations, the adjusted relative risk for composite severe maternal morbidity for postpartum hospitalizations was 4.68 (95% confidence interval [CI]: 4.33, 5.05). Most of this difference was driven by rates of sepsis (53.2 vs. 11.0 vs. 10.9%). Though relatively uncommon, postpartum hospitalizations for pyelonephritis are associated with higher rates of severe maternal morbidity, driven by differential rates of sepsis, than are antepartum or delivery-associated hospitalizations.

47-Year-Old Woman With Bilateral Flank Pain

47-Year-Old Woman With Bilateral Flank Pain

Diagnostic value of determination of sialic acid and protein fractions in blood serum with prostate adenoma and pyelonephritis

In most patients with prostate adenoma in the second and third stages of the disease, the course of the process is complicated by an infection localized not only in the urinary tract, but also in the kidneys (pyelonephritis). Timely diagnosis of pyelonephritis is important for the prognosis and treatment of patients with prostate adenoma.

Pielonefritis en el anciano hospitalizado: uso de un antibiótico habitual y la adecuación a las guías

IntroductionPyelonephritis in the elderly present high incidence and morbidity-mortality. The increase in resistance makes good empirical handling essential. MethodsRetrospective observational study in people over 65 years old admitted during 2012-2017 to Palencia and Salamanca hospitals with a diagnosis of pyelonephritis. Inadequate empirical antibiotic treatment was defined if it conformed to the indications of the SEIMC Guide (2016). Results292 episodes, mean age 82±10 years, 48.3% male. Escherichia coli 53.8% and Klebsiella spp 8. 9% were the most frequently microbiological isolation found. 180 episodes (61.6%) received inadequate empirical treatment. The two most frequent causes were the use of antibiotics not included in the guidelines 107 (59.5%) and the use of 2nd-3rd generation cephalosporins in patients with risk factors for Extended spectrum betalactamases 63 (35%). Absence of identification of risk factors of extended-spectrum betalactamases was found associated to inadequate empirical antibiotic treatment (p<0,05). Inadequate treatment did not increase mortality (p>0.05). ConclusionsThe adequacy of antibiotic use in the elderly admitted for pyelonephritis according to the SEIMC Guidelines is low. The lack of identification of risk factors for betalactamases-producing Enterobacteriacea was the main factor involved. Inadequate empirical treatment was not associated with increased mortality.

384 What Proportion of Pyelonephritis Admissions Under Urology Care Have Surgical Pathology

Abstract Aim To identify the proportion of pyelonephritis patients admitted with true urological pathology Method Retrospective audit Results The majority of adults admitted with diagnosis of pyelonephritis (80%) remain under urology team from 1st day of admission Of the 80% only 9% had an underlying urological pathology confirmed by imaging AND requiring invasive intervention Conclusions High rate of inappropriate admission to surgical / urological ward with subsequent pressure on beds and inevitable cancellations on some occasions Acute pyelonephritis should not be routinely admitted under urology unless there is clear evidence of underlying obstructing pathology or no obvious improvement on antibiotics Consider imaging in terms of US/CT KUB in first instance before making any referral to urology

Renal Parenchymal Hypoxia in Young Children in the Period of Complete Remission of Acute Uncomplicated Pyelonephritis without Renal Impairment

Introduction. After establishing the diagnosis of pyelonephritis, there is a need to determine, whether renal parenchymal hypoxia remains in the period of remission. The least studied methods up to now are functional ones, which allow to verify the presence and degree of tissue hypoxia in secondary pyelonephritis and to evaluate the results of the medical measures to restore kidney function. Objective: to clarify the presence of renal parenchymal hypoxia and membrane destruction of the renal epithelium in young children with pyelonephritis without anatomic congenital malformations of the urinary system during its remission.Materials and methods of the study. The study involved 65 children with acute uncomplicated pyelonephritis, who after nephro-urological examination did not reveal anatomical malformations of the urinary system. General clinical examination was carried out, markers of tissue hypoxia and morphofunctional state of cell membranes of renal epithelium were determined.Discussion of the study results. The ability of urine to prevent crystal formation was significantly reduced to oxalates and phosphates in 40.0 and 47.7 % of the surveyed children. In one-third of children with pyelonephritis, oxalate excretion was significantly higher than in healthy children, hypophosphaturia was detected in 52.3 % of cases and the tendency to reduce the excretion of urates in 10.8 % of pediatric patients with pyelonephritis. The content of lipid peroxidation products in urine was increased in 41.5 % of the surveyed children with pyelonephritis, and appearance of polar lipids was observed in 46.2 % of patients.Conclusions. To predict the formation and for the purpose of early diagnosis of renal parenchymal hypoxia and the processes of nephrothelial membrane destruction in young children with pyelonephritis, it is recommended to use such markers, as indicators of urine ability to prevent crystal formation, daily excretion of salts, excretion of lipid peroxidation products and polar lipids in the urine. It is recommended to apply the methods to correct these changes.

Significance of Asymptomatic Pyelonephritis Found on Kidney Transplant Biopsy.

Background.The clinical significance and appropriate management of graft pyelonephritis diagnosed by biopsy are poorly understood.Methods.We analyzed data from all patients with pyelonephritis on transplant kidney biopsy from January 1998 to December 2019. Patients were divided into 2 groups: those whose urinalysis was positive for urinary tract infection (UA+) and those whose urinalysis was negative (UA–).Results.There were a total of 101 patients with the diagnosis of pyelonephritis by biopsy during the study period. The mean time from transplant to pyelonephritis diagnosis was 3.3 ± 4 y. Thirty-six (35.6%) of the patients with pyelonephritis on biopsy had a negative UA. Out of 65 patients in the UA+ group, 54 (83%) received antibiotics. Only 12 of the UA– patients (33%) received antibiotics. The use of antibiotics in both the UA+ (P = 0.03) and UA– groups (P = 0.02) compared with no use of antibiotics was associated with better death-censored graft survival. On multivariate analysis, the use of antibiotics (hazard ratio = 0.22, P = 0.001, 95% confidence interval, 0.12-0.61) was associated with improved graft survival.Conclusion.The finding of pyelonephritis on a transplant kidney biopsy is almost always a surprise but is an important finding. Treatment with antibiotics, regardless of signs or symptoms of urinary tract infection, is associated with improved graft survival.

Retrospective Study on Hospital Admissions due to Pyelonephritis in Type II Diabetic Patients

Background: Pyelonephritis is a urinary tract infection that ascends to involve the kidneys. It can also occur as an infection secondary to bacteremia. Some pathogens that commonly cause pyelonephritis are E. coli, enterobacteriaceae, staphylococci, and pseudomonas. The initial patient presentation usually involves fever, chills, nausea, vomiting, costovertebral angle tenderness, and flank pain. Other cystitis symptoms such as dysuria, increased urinary frequency, malodorous urine, and hematuria may or may not be present. Symptoms of pyelonephritis with bacteriuria are sufficient for the diagnosis of pyelonephritis. Aim: The aim of this study was to investigate a potential link between Type II Diabetes Mellitus and pyelonephritis. Methods: In this retrospective study, hospitalized patients during the study period were reviewed. Variables examined were sex, age, and length of stay. Patients were excluded if they had known urogenital abnormalities, indwelling catheters (Foley, nephrostomy, suprapubic, or who regularly perform clean intermittent catheterization), were pregnant, or were on dialysis. Results: Of 333 patients analyzed, diabetics had a longer length of stay then non-diabetics (4.49 vs 3.67 days respectively; p=0.0041) and females were significantly younger than men in hospitalized patients for pyelonephritis were (50.0 vs 63.5 years; p=&lt;0.0001). Further, it was found that diabetics were significantly older than nondiabetics were (60.4 vs 47.3; p=&lt;0.0001) and more diabetics getting admitted with pyelonephritis were men vs women (59.32% vs 35.27%; p=0.0007). Conclusion: Results of the study were significant in showing that of all pyelonephritis-hospitalized patients on average the length of stay was longer for diabetics and it demonstrated that female patients with pyelonephritis are significantly younger than male patients hospitalized with pyelonephritis. Of note, there was no significant difference in the length of stay for diabetic patients based on their treatment modality (diet controlled vs. oral medications vs. insulin dependent vs. combined). The study also showed that diabetics getting admitted for pyelonephritis are more men and older in age compared to the nondiabetics.