[Approach of renal parenchyma infection: retrospective study of period 2005-2007]. / Abordaje de la infección aguda del parénquima renal: estudio retrospectivo de los años 2005-2007.

BACKGROUND: The renal parenchyma acute infection, known as acute pyelonephritis (APN), is diagnosed and treated in some Hospital Departments of the H.C.U. Lozano Blesa. We want to know if the process was made in a homogeneous way, fixed to the described quality standards and if we could detect improvement areas. METHODS: Retrospective study in admitted patients with the diagnosis of APN over and 2 year period (11-05/10-07), evaluating some variables referred to epidemiological data, diagnosis, treatment and evolution. RESULTS: We studied 118 patients (80.5% women, mean age 34 years), that supposed 0.39% of patients admitted from the Emergency Department (36% in Urology and the rest in Paediatric, Obstetric, Internal Medicine and others).45% showed risk factors (urinary anomalies, diabetes, pregnancy, immunosuppressant, ...), and it is considered complicated APN (CAPN). In children there was a high rate of urinary tract malformations. Diagnosis was clinical in 82.2%. The rest required imaging techniques, specially children, using gamma scan. In 82.7% there was leukocyturia and in 79.9% leukocytosis. A urine culture pre-treatment was made in 76.3%, with a positive rate of 55.5%, detecting negative Gram germs in 94% (E. coli in 82%). Treatment was empiric in all cases, based on cephalosporin, amoxicillin/clavulanic acid and fluoroquinilones. Evolution was favorable in 93.1% (95.1% of NCAPN and 85.7% of CAPN). The mean hospital stay was 6.4 days (5.6 in NCAPN and 7.5 in CAPN). CONCLUSIONS: Acute pyelonephritis management in our hospital is highly satisfactory and similar to the revised medical literature. We could emphasize the low rate of urinary cultures pretreatment (negative in quite a lot of the cases, due to early beginning of antibiotic treatment) and that mean hospital stay could be reduced in CAPN. We want to congratulate all involved professionals at the hospital for the good practice demonstrated.

Abordaje de la infección aguda del parénquima renal: Estudio retrospectivo de los años 2005-2007 / Approach of the renal parenchyma infection: retrospective study of period 2005-2007

OBJETIVO: La infección aguda del parénquima renal, conocida como pielonefritis aguda (PNA), es diagnosticada y tratada en diversos Servicios del H.C.U. Lozano Blesa. Deseábamos averiguar si el proceso se realizaba de forma homogénea, ajustándose a los estándares de calidad descritos y si podíamos detectar áreas de mejora.MÉTODOS: Estudio retrospectivo de pacientes ingresados con el diagnóstico de PNA, durante 2 años (11-05/10-07), valorándose diversas variables, referidas a datos epidemiológicos, diagnóstico, tratamiento y evolución.RESULTADOS: Se analizaron 118 pacientes (80,5% mujeres, edad media 34 años), que suponían el 0,39% de ingresos procedentes del S. Urgencias (el 36% en Urología y el resto en Pediatría, Obstetricia, Medicina Interna y otros Servicios).El 45% presentaba factores de riesgo (anomalías urinarias, diabetes, embarazo, inmunosupresión, etc.), considerándose como PNA complicadas (PNAC). Entre los niños hubo una elevada tasa de malformaciones del tracto urinario.El diagnóstico fue clínico en el 82,2%. El resto precisó técnicas de imagen, sobre todo los niños, en los que se utilizó gammagrafía. El 87,2% presentaban leucocituria y el 79,9% leucocitosis. Se realizó urocultivo pre-tratamiento en el 76,3%, con una tasa de positividad del 55,5%, detectándose gérmenes Gram negativos en el 94% (E. coli en el 82%).El tratamiento fue empírico en todos los casos, a base de cefalosporinas, amoxicilina/clavulánico y fluorquinolonas. La evolución fue favorable en el 93,2% de pacientes (95,1% de las PNANC y 85,7% de las PNAC).La estancia media global fue de 6,4 días (5,6 en PNANC y 7,5 en PNAC)(AU)

CONCLUSIONES: A la luz de la literatura revisada hemos comprobado que el manejo de esta patología, tal y como se lleva a cabo en el H.C.U. Lozano Blesa es altamente satisfactorio y se aproxima mucho a lo publicado por otros autores.Cabría destacar que se ha detectado una baja tasa de urocultivos pre-tratamiento, que los resultados de éstos son negativos en demasiados casos (por inicio precoz del tratamiento antibiótico) y que la estancia media, en la no complicada, debería reducirse.Queremos felicitar a todos los profesionales del Centro, implicados en el proceso analizado, por la “buena praxis” demostrada(AU)

OBJECTIVES: The renal parenchyma acu-te infection, known as acute pyelonephritis (APN), is diagnosed and treated in some Hospital Departments of the H.C.U. Lozano Blesa. We want to know if the process was made in a homogeneous way, fixed to the described quality standards and if we could detect im-provement areas.METHODS: Retrospective study in admitted patients with the diagnosis of APN over and 2 year period (11-05/10-07), evaluating some variables referred to epidemiological data, diagnosis, treatment and evolution.RESULTS: We studied 118 patients (80.5% women, mean age 34 years), that supposed 0.39% of patients admitted from the Emergency Department (36% in Urology and the rest in Paediatric, Obstetric, Internal Medicine and others).45% showed risk factors (urinary anomalies, diabetes, pregnancy, immunosuppressant, …), and it is considered complicated APN (CAPN). In children there was a high rate of urinary tract malformations.Diagnosis was clinical in 82.2%. The rest required ima-ging techniques, specially children, using gamma scan. In 82.7 % there was leukocyturia and in 79.9% leukocytosis. A urine culture pre-treatment was made in 76.3%, with a positive rate of 55.5%, detecting negative Gram germs in 94% (E. coli in 82%).Treatment was empiric in all cases, based on cephalosporin, amoxicillin/clavulanic acid and fluoroquinilones. Evolution was favorable in 93.1% (95.1% of NCAPN and 85.7% of CAPN).The mean hospital stay was 6.4 days (5.6 in NCAPN and 7.5 in CAPN).CONCLUSIONS: Acute pyelonephritis management in our hospital is highly satisfactory and similar to the revised medical literature.We could emphasize the low rate of urinary cultures pre-treatment (negative in quite a lot of the cases, due to early beginning of antibiotic treatment) and that mean hospital stay could be reduced in CAPN.We want to congratulate all involved professionals at the hospital for the good practice demonstrated(AU)