Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study.


Autoria(s): Buonaiuto, Veronica A; Marquez, Ignacio; De Toro, Inmaculada; Joya, Carolina; Ruiz-Mesa, Juan D; Seara, Raimundo; Plata, Antonio; Sobrino, Beatriz; Palop, Begoña; Colmenero, Juan D
Data(s)

14/01/2016

14/01/2016

10/12/2014

Resumo

BACKGROUND Complicated pyelonephritis (cPN), a common cause of hospital admission, is still a poorly-understood entity given the difficulty involved in its correct definition. The aim of this study was to analyze the main epidemiological, clinical, and microbiological characteristics of cPN and its prognosis in a large cohort of patients with cPN. METHODS We conducted a prospective, observational study including 1325 consecutive patients older than 14 years diagnosed with cPN and admitted to a tertiary university hospital between 1997-2013. After analyzing the main demographic, clinical and microbiological data, covariates found to be associated with attributable mortality in univariate analysis were included in a multivariate logistic regression model. RESULTS Of the 1325 patients, 689 (52%) were men and 636 (48%) women; median age 63 years, interquartile range [IQR] (46.5-73). Nine hundred and forty patients (70.9%) had functional or structural abnormalities in the urinary tract, 215 (16.2%) were immunocompromised, 152 (11.5%) had undergone a previous urinary tract instrumentation, and 196 (14.8%) had a long-term bladder catheter, nephrostomy tube or ureteral catheter. Urine culture was positive in 813 (67.7%) of the 1251 patients in whom it was done, and in the 1032 patients who had a blood culture, 366 (34%) had bacteraemia. Escherichia coli was the causative agent in 615 episodes (67%), Klebsiella spp in 73 (7.9%) and Proteus ssp in 61 (6.6%). Fourteen point one percent of GNB isolates were ESBL producers. In total, 343 patients (25.9%) developed severe sepsis and 165 (12.5%) septic shock. Crude mortality was 6.5% and attributable mortality was 4.1%. Multivariate analysis showed that an age >75 years (OR 2.77; 95% CI, 1.35-5.68), immunosuppression (OR 3.14; 95% CI, 1.47-6.70), and septic shock (OR 58.49; 95% CI, 26.6-128.5) were independently associated with attributable mortality. CONCLUSIONS cPN generates a high morbidity and mortality and likely a great consumption of healthcare resources. This study highlights the factors directly associated with mortality, though further studies are needed in the near future aimed at identifying subgroups of low-risk patients susceptible to outpatient management.

Journal Article; Observational Study; Research Support, Non-U.S. Gov't;

This work was supported by Consejería de Salud y Bienestar Social de la Junta de Andalucía, Grant PI-0289-2012.

Identificador

Buonaiuto VA, Marquez I, De Toro I, Joya C, Ruiz-Mesa JD, Seara R, et al. Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study. BMC Infect. Dis. 2014; 14:639

1471-2334 (Online)

PMC4267459

http://hdl.handle.net/10668/2131

25492862

10.1186/s12879-014-0639-4

Idioma(s)

en

Publicador

BioMed Central

Relação

BMC Infectious Diseases

http://www.biomedcentral.com/1471-2334/14/639/abstract

Direitos

Acceso abierto

Palavras-Chave #Urinary tract infection #Complicated #Epidemiology #Prognosis #Bacteriemia #Estudios de cohortes #Modelos logísticos #Estudios prospectivos #Pielonefritis #Factores de riesgo #España #Medical Subject Headings::Named Groups::Persons::Age Groups::Adult #Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged #Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation::Systemic Inflammatory Response Syndrome::Sepsis::Bacteremia #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies #Medical Subject Headings::Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Escherichia::Escherichia coli #Medical Subject Headings::Check Tags::Female #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization #Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals::Hospitals, Teaching::Hospitals, University #Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans #Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Logistic Models #Medical Subject Headings::Check Tags::Male #Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies #Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Nephritis::Pyelitis::Pyelonephritis #Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors #Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain #Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Young Adult #Medical Subject Headings::Named Groups::Persons::Age Groups::Adolescent
Tipo

info:eu-repo/semantics/article

info:eu-repo/semantics/published

Artículo