RT Journal Article
T1 Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study.
A1 Buonaiuto, Veronica A
A1 Marquez, Ignacio
A1 De Toro, Inmaculada
A1 Joya, Carolina
A1 Ruiz-Mesa, Juan D
A1 Seara, Raimundo
A1 Plata, Antonio
A1 Sobrino, Beatriz
A1 Palop, Begoña
A1 Colmenero, Juan D
K1 Urinary tract infection
K1 Complicated
K1 Epidemiology
K1 Prognosis
K1 Bacteriemia
K1 Estudios de cohortes
K1 Modelos logísticos
K1 Estudios prospectivos
K1 Pielonefritis
K1 Factores de riesgo
K1 España
AB BACKGROUNDComplicated 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.METHODSWe 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.RESULTSOf 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.CONCLUSIONScPN 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.
PB BioMed Central
YR 2014
FD 2014-12-10
LK http://hdl.handle.net/10668/2131
UL http://hdl.handle.net/10668/2131
LA en
NO 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
NO Journal Article; Observational Study; Research Support, Non-U.S. Gov't;
DS RISalud
RD Apr 11, 2025