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1.
J Infect Chemother ; 25(10): 791-796, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103341

RESUMO

OBJECTIVES: To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN). MATERIALS: Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Correlation between PLR and other variables was done using Pearson correlation coefficient. Univariate and multivariate analyses for sepsis and mortality were performed. RESULTS: Of fifty four patients, 38 patients had SIRS ≥2 criteria on admission. Twenty patients developed sepsis requiring ICU admission. In univariate analysis, male gender, lower BMI, higher INR, higher WBCs count and lower PLR were associated with sepsis (P = 0.0001, 0.009, 0.04, 0.003 and 0.001, respectively). In multivariate analysis, PLR ≤18.4, male sex and BMI ≤24.2 were independent risk factors. Lower PLR directly correlated with serum albumin (P = 0.01) and inversely correlated with serum creatinine and random blood glucose level and Klebsiella infection (P = 0.001, 0.007 and 0.005, respectively). Also, it was correlated with a higher total score of qSOFA and SOFA (P = 0.02 and 0.04). Lower PLR was independent risk factors for death in EPN patients with (P = 0.003). CONCLUSION: EPN is associated with sepsis development. Lower PLR is an independent simple predictor for sepsis and mortality in patients with EPN.


Assuntos
Enfisema/sangue , Pielonefrite/sangue , Choque Séptico/diagnóstico , Adulto , Enfisema/complicações , Enfisema/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Rim/patologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Pielonefrite/complicações , Pielonefrite/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Choque Séptico/etiologia , Choque Séptico/mortalidade
2.
J Korean Med Sci ; 33(49): e310, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30505253

RESUMO

Background: Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. Methods: From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. Results: The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). Conclusion: The epidemiology of APN in Korea has been changing with an increasing incidence rate.


Assuntos
Pielonefrite/epidemiologia , Doença Aguda , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Pielonefrite/mortalidade , Recidiva , República da Coreia/epidemiologia
3.
J Urol ; 199(6): 1526-1533, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29291417

RESUMO

PURPOSE: The Third International Consensus Definitions for Sepsis and Septic Shock Task Force proposed a new definition of sepsis based on the SOFA (Sequential [Sepsis-related] Organ Failure Assessment) score and introduced a novel scoring system, quickSOFA, to screen patients at high risk for sepsis. However, the clinical usefulness of these systems is unclear. Therefore, we investigated predictive performance for mortality in patients with acute pyelonephritis associated with upper urinary tract calculi. MATERIALS AND METHODS: This retrospective study included 141 consecutive patients who were clinically diagnosed with acute pyelonephritis associated with upper urinary tract calculi outside the intensive care unit. We evaluated the performance of the quickSOFA, SOFA and SIRS (systemic inflammatory response syndrome) scores to predict in-hospital mortality and intensive care unit admission using the AUC of the ROC curve, net reclassification, integrated discrimination improvements and decision curve analysis. RESULTS: A total of 11 patients (8%) died in the hospital and 26 (18%) were admitted to the intensive care unit. The AUC of quickSOFA to predict in-hospital mortality and intensive care unit admission was significantly greater than that of SIRS (each p <0.001) and comparable to that of SOFA (p = 0.47 and 0.57, respectively). When incorporated into the baseline model consisting of patient age, gender and the Charlson Comorbidity Index, quickSOFA and SOFA provided a greater change in AUC, and in net classification and integrated discrimination improvements than SIRS for each outcome. Decision curve analyses revealed that the quickSOFA and SOFA incorporated models showed a superior net benefit compared to the SIRS incorporated model for most examined probabilities of the 2 outcomes. The in-hospital mortality rate of patients with a quickSOFA score of 2 or greater and a SOFA score of 7 or greater, which were the optimal cutoffs determined by the Youden index, was 18% and 28%, respectively. CONCLUSIONS: SOFA and quickSOFA are more clinically useful scoring systems than SIRS to predict mortality in patients with acute pyelonephritis associated with upper urinary tract calculi.


Assuntos
Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Pielonefrite/mortalidade , Choque Séptico/mortalidade , Cálculos Urinários/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Valor Preditivo dos Testes , Prognóstico , Pielonefrite/etiologia , Estudos Retrospectivos , Medição de Risco , Choque Séptico/diagnóstico , Choque Séptico/etiologia
4.
Medicine (Baltimore) ; 96(43): e8371, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29069028

RESUMO

Severe sepsis or septic shock are the main factors influencing the prognosis of acute pyelonephritis (APN). Our aim was to analyze factors associated with the development of severe sepsis or septic shock in a large sample of patients with acute complicated pyelonephritis (ACPN).This prospective observational study comprised 1507 consecutive patients aged 14 years or older who were admitted to a tertiary care hospital because of ACPN between 1997 and 2015. Covariates associated in univariate analysis with severe sepsis or septic shock were then analyzed by multivariate logistic regression.Of the 1507 patients, 423 (28.1%) fulfilled the criteria for severe sepsis or septic shock at the time of admission. Crude and attributable mortality at 30 days were 17.7% and 11.7% in patients with severe sepsis or septic shock versus 1.7% and 0.6% in patients without severe sepsis or septic shock, P < .0001 and P < .0005, respectively. An age > 65 years, urinary instrumentation in the previous 2 weeks, the lack of mictional syndrome or costovertebral tenderness, an ectasia ≥ grade II, and bacteremia were independent risk factors associated with severe sepsis or septic shock.The prevalence of severe sepsis and septic shock in patients with ACPN is high. Some factors associated with severe sepsis are easy to identify in any emergency department. The information provided here could be useful when deciding which patients should be admitted to receive immediate treatment.


Assuntos
Pielonefrite/microbiologia , Sepse/mortalidade , Choque Séptico/mortalidade , Doença Aguda , Idoso , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Prospectivos , Pielonefrite/mortalidade , Fatores de Risco , Sepse/microbiologia , Choque Séptico/microbiologia
5.
Nephrol Ther ; 12(7): 508-515, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27789323

RESUMO

INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare and severe, necrotizing infection of the kidney. Diagnosis should be precocious based on computed tomography (CT). Its management remains controversial and its treatment is currently increasingly conservative. The aim of this paper is to discuss the conservative treatment of this disease through our experience in 21 patients. MATERIAL AND METHODS: A retrospective analysis including 21 patients managed conservatively for an emphysematous pyelonephritis in our department from January 2010 to April 2015. Follow-up ranged from three to 24 months. RESULTS: Of the 24 patients, seven belonged to class 1, twelve to class 2 and two to class 4. Obstruction of the upper urinary tract was found in 16 cases. On the risk factor stratification, thrombocytopenia was found in five cases, renal function impairment in 10 cases and a septic shock in four cases. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad-spectrum antibiotics. Drainage of the urinary tract was performed by double-J stent in 14 patients and with ureteral catheter in six patients. One patient had urinary distension secondary to a urethral stricture with bilateral emphysematous pyelitis. In this case, drainage consisted in suprapubic bladder catheter only. The outcome was favorable in 18 patients and the control CT showed a decline or complete disappearance of gas in urinary tract and/or renal parenchyma after an average period of 12 days. A secondary nephrectomy was performed in two cases. Specific mortality rate was zero. CONCLUSION: PNE remains a severe infection involving the vital prognosis. Computed tomography makes an early diagnosis. Treatment should be conservative based on the association of medical intensive care and drainage, percutaneous or endoscopic, urgently. Nephrectomy should be reserved for extensive forms with multiple organ dysfunction or failure of conservative treatment.


Assuntos
Antibacterianos/uso terapêutico , Enfisema/microbiologia , Enfisema/terapia , Infecções por Escherichia coli , Hidratação , Infecções por Klebsiella , Pielonefrite/microbiologia , Pielonefrite/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/métodos , Enfisema/diagnóstico , Enfisema/mortalidade , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/mortalidade , Infecções por Escherichia coli/terapia , Feminino , Hidratação/métodos , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/mortalidade , Infecções por Klebsiella/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Pielonefrite/diagnóstico , Pielonefrite/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Sucção/métodos , Resultado do Tratamento
6.
Rev Med Inst Mex Seguro Soc ; 54 Suppl 2: S156-61, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27561019

RESUMO

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.


Assuntos
Enfisema/diagnóstico , Pielonefrite/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Enfisema/etiologia , Enfisema/mortalidade , Enfisema/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Prognóstico , Pielonefrite/etiologia , Pielonefrite/mortalidade , Pielonefrite/terapia , Estudos Retrospectivos , Fatores de Risco
7.
Am J Emerg Med ; 34(9): 1788-93, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27321936

RESUMO

OBJECTIVE: The objectives of this study are to investigate the performance of the quick Sepsis-related Organ Failure Assessment (qSOFA) in predicting mortality and intensive care unit (ICU) admission in patients with clinically diagnosed infection and to compare its performance with that of Mortality in Emergency Department Sepsis (MEDS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sepsis-related Organ Failure Assessment (SOFA). METHODS: From July to December 2015, we retrospectively analyzed 477 patients clinically diagnosed with infection in the emergency department. We compared the performance of SOFA, MEDS, APACHE II, and qSOFA in predicting ICU admission and 28-day mortality. RESULTS: All scores were higher in nonsurvivors and ICU patients than in survivors and non-ICU patients (P< .001). The area under the receiver operating characteristic curve of qSOFA was lower than that of MEDS (0.666 vs 0.751; P< .05) and similar to that of SOFA (0.729) and APACHE II (0.732) in predicting 28-day mortality. The areas under the receiver operating characteristic curve of qSOFA, SOFA, MEDS, and APACHE II in predicting ICU admission were 0.636, 0.682, 0.661, and 0.640, respectively. There were no significant differences among the score systems. In patients with qSOFA scores less than 2 and greater than or equal to 2, 28-day mortality rates were 17.4% and 42.9% (P< .001), and ICU admission rates were 16.0% and 33.3% (P< .001). CONCLUSIONS: Quick SOFA predicted ICU admission with similar performance to that of SOFA, MEDS, and APACHE II. Its prognostic ability was similar to that of SOFA and APACHE II but slightly inferior to that of MEDS.


Assuntos
Infecções do Sistema Nervoso Central/mortalidade , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Intra-Abdominais/mortalidade , Pneumonia/mortalidade , Pielonefrite/mortalidade , Sepse/mortalidade , Infecções dos Tecidos Moles/mortalidade , APACHE , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Escores de Disfunção Orgânica , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias Infecciosas/mortalidade
8.
Medicine (Baltimore) ; 95(21): e3573, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27227920

RESUMO

The aim of this study was to investigate the profiles of pathogens and patterns of antibiotic resistance of emphysematous pyelonephritis (EPN), offering recommendations for initial antibiotic treatment.Between January, 2001, and November, 2014, demographic data, presenting clinical features, management strategies, and treatment outcomes of 51 patients with EPN were retrospectively reviewed, analyzing microbiological characteristics of causative pathogens and patterns of antibiotic resistance.Overall survival rate was 90.2% (46/51). Pathogens isolated most frequently were Escherichia coli (49.0%), Klebsiella pneumoniae (19.6%), and Proteus mirabilis (17.7%). Approximately 24% of E coli isolates and 22% K pneumoniae isolates were resistant to fluoroquinolones. Improper empiric antibiotic use (P = 0.02) and third-generation cephalosporin-resistant pathogens (G3CRP) (P = 0.01) were significantly more common in cases of patient fatality. Prior hospitalization and antibiotic use within past year (P = 0.03), need for emergency hemodialysis (P = 0.03), and development of disseminated intravascular coagulation (DIC) (P = 0.03) were factors correlating significantly with microbial resistance to third-generation cephalosporins. The area under the receiver operating characteristic curve was 0.91. The cut-off point determined by the maximum Youden index for 2 of these 3 factors yielded a sensitivity of 0.8 and specificity of 0.93.Third-generation cephalosporins are recommended as initial treatment of EPN. In patients with histories of prior hospitalization and antibiotic use and in those needing emergency hemodialysis or developing DIC, carbapenem is the empiric antibiotic of choice. Patients presenting with 2 or more factors carry the highest risk of G3CRP involvement. Fluoroquinolone and gentamicin should be avoided.


Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Feminino , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/mortalidade , Estudos Retrospectivos , Fatores Sexuais
10.
Urologiia ; (1): 46-50, 2016 Feb.
Artigo em Russo | MEDLINE | ID: mdl-28247703

RESUMO

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Nefrectomia , Pielonefrite/mortalidade , Pielonefrite/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pielonefrite/complicações , Pielonefrite/diagnóstico por imagem
11.
J Surg Res ; 198(1): 175-84, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26073350

RESUMO

BACKGROUND: Based on previous animal studies showing promising immunomodulatory efficacy esmolol, a selective ß1-blocker, it was assumed that administration of esmolol in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa would prolong survival and modulate immune response. METHODS: Acute pyelonephritis was induced in 80 rabbits and assigned to eight groups receiving normal saline (controls), esmolol, amikacin, or both agents as pretreatment and as treatment. Blood was sampled for measurement of malondialdehyde and tumor necrosis factor alpha. Animals were followed up for survival, and after death quantitative tissue cultures were performed. The in vitro effect of esmolol on bacterial growth and on the oxidative burst of neutrophils of healthy controls and of sepsis patients was studied. RESULTS: Survival of pretreatment groups administered single esmolol or esmolol and amikacin was prolonged compared with that of controls (P = 0.018 and P = 0.014, respectively); likewise, survival of treatment groups administered single esmolol or both agents was prolonged compared with that of controls (P = 0.007 and P = 0.014, respectively). Circulating malondialdehyde was significantly lower in pretreated animals administered esmolol or esmolol and amikacin compared with that in controls and in treated animals administered both agents compared with in controls (P = 0.020). In these groups, the bacterial load of the lung was significantly lower compared with controls. Serum tumor necrosis factor alpha did not change. Amikacin was increased in serum of esmolol-treated animals at levels which inhibited the in vitro growth of the studied isolate. Esmolol did not modify the in vitro growth of P aeruginosa and the oxidative burst of neutrophils. CONCLUSIONS: It is concluded that esmolol prolonged survival after experimental infection by multidrug-resistant P aeruginosa. Survival benefit may be related with pleiotropic actions connected with modulation of pharmacokinetics and attenuation of inflammation.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Fatores Imunológicos/uso terapêutico , Propanolaminas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Pielonefrite/tratamento farmacológico , Animais , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Malondialdeído/sangue , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/efeitos dos fármacos , Pielonefrite/mortalidade , Coelhos
12.
Med Intensiva ; 39(5): 290-7, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25444058

RESUMO

PURPOSE: The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. DESIGN: A retrospective observational study covering a 16-year period (2006-2011) was carried out. SETTING: The combined clinical/surgical ICU of a secondary-level University hospital. PATIENTS: All patients admitted to the ICU due to obstructive urinary sepsis. INTERVENTIONS: None. MAIN VARIABLES: We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. RESULTS: A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality. CONCLUSIONS: Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.


Assuntos
Pielonefrite/mortalidade , Cálculos Ureterais/complicações , Obstrução Ureteral/complicações , Doença Aguda , Lesão Renal Aguda/etiologia , Fatores Etários , Idoso , Comorbidade , Dopamina/uso terapêutico , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Mortalidade Hospitalar , Humanos , Hidronefrose/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Pielonefrite/etiologia , Pielonefrite/microbiologia , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/etiologia , Choque Séptico/mortalidade , Espanha/epidemiologia
13.
BMC Infect Dis ; 14: 639, 2014 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-25492862

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.


Assuntos
Pielonefrite/epidemiologia , Adolescente , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Estudos de Coortes , Escherichia coli/isolamento & purificação , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Universitários , Humanos , Klebsiella/isolamento & purificação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Pielonefrite/complicações , Pielonefrite/microbiologia , Pielonefrite/mortalidade , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
14.
Saudi J Kidney Dis Transpl ; 25(4): 823-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24969195

RESUMO

Emphysematous pyelonephritis (EPN) is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings) was studied. A total of 12 patients were studied, including 10 with diabetes. A total of 66.6% had pyelonephritis, 25% had both cystitis and pyelonephritis and 8.3% had only cystitis; involvement of the left kidney was more common and bilateral involvement was seen in two cases. The clinical features seen in the patients included fever (100%), features of urinary infection (66.6%) and flank pain (50%). Culture positivity was seen in only 50% of the cases. Ten patients underwent percutaneous drainage (PCD) within 24 h, and two of these patients required nephrectomy subsequently. All patients were followed-up for one month. There was one death (mortality 8.3%), and all other patients responded well and recovered. Our study suggests that EPN is a potentially life-threatening condition that requires aggressive and prompt medical therapy with early PCD to reduce morbidity and mortality. Nephrectomy should be reserved for cases that do not respond to PCD.


Assuntos
Cistite , Enfisema , Pielonefrite , Adulto , Idoso , Cistite/diagnóstico , Cistite/microbiologia , Cistite/mortalidade , Cistite/cirurgia , Drenagem , Enfisema/diagnóstico , Enfisema/microbiologia , Enfisema/mortalidade , Enfisema/cirurgia , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pielonefrite/diagnóstico , Pielonefrite/microbiologia , Pielonefrite/mortalidade , Pielonefrite/cirurgia , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
15.
Urology ; 83(6): 1280-4, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24726310

RESUMO

OBJECTIVE: To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS: We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS: A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION: EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.


Assuntos
Enfisema/microbiologia , Enfisema/terapia , Pielonefrite/patologia , Pielonefrite/terapia , Adulto , Fatores Etários , Idoso , Análise de Variância , Antibacterianos , Administração de Caso , Estudos de Coortes , Drenagem/métodos , Enfisema/mortalidade , Feminino , Humanos , Testes de Função Renal , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Análise Multivariada , Nefrectomia/métodos , Pielonefrite/complicações , Pielonefrite/mortalidade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Taxa de Sobrevida , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
16.
Hong Kong Med J ; 20(4): 285-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24625386

RESUMO

OBJECTIVE. To review demographics of patients with acute pyelonephritis, their outcomes of severe upper urinary tract infection, and to identify risk factors for long hospital stay and mortality. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients admitted between June 2007 and June 2012 for acute pyelonephritis were identified. Those with the most severe outcomes were analysed of their mortality, need for care in the intensive care unit, or necessitation of urological intervention. RESULTS. Overall, 68 patients fulfilled our criteria for severe acute pyelonephritis. The female-to-male ratio was 7:3. Their mean age was 58 years. Overall, 57% of the patients had impaired renal function and 37% were diabetic; 47% developed shock after admission and 56% required further intensive care unit care; 75% of the patients demonstrated radiological evidence of urinary tract obstruction and required subsequent drainage procedures. Five patients died due to severe acute pyelonephritis. The prevalence of bacteraemia and bacteriuria was 57% and 74%, respectively. Escherichia coli accounted for the majority of causative organisms. Four risk factors-bacteraemia, shock, need for intensive care, and suppurative pyelonephritis-were associated with hospital stay of longer than 14 days. Old age (≥65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. CONCLUSION. There was high prevalence of bacteraemia and septic shock in patients with severe acute pyelonephritis. The factors of old age (≥65 years), male sex, deranged renal function, and presence of disseminated intravascular coagulation were associated with mortality. With the support of intensive care, early recognition of urinary tract obstruction and timely drainage, patients with severe acute pyelonephritis generally carry a good prognosis.


Assuntos
Bacteriemia/epidemiologia , Pielonefrite/terapia , Choque Séptico/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Criança , Drenagem/métodos , Feminino , Hong Kong , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Pielonefrite/mortalidade , Pielonefrite/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
17.
Int J Urol ; 21(3): 277-82, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24033515

RESUMO

OBJECTIVES: Emphysematous pyelonephritis is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. The aim of the present study was to determine the clinical characteristics and prognostic factors of patients with emphysematous pyelonephritis. METHODS: We retrospectively analyzed the clinical and laboratory data, imaging findings, and outcomes of 32 patients with emphysematous pyelonephritis. Receiver operating characteristic curve analysis was carried out on variables that were significantly associated with patient mortality. RESULTS: The overall survival rate was 87.5% (28/32). Escherichia coli (43.6%) was the most common organism cultured from urine and blood specimens. Hypoalbuminemia, shock as the presenting feature, bacteremia, need for hemodialysis and polymicrobial infection were significantly more common in cases resulting in death. The area under the receiver operating characteristic curve was 0.96. The cut-off point determined by the maximum Youden index (0.93) for three of these five factors yielded a sensitivity of 1.00 and specificity of 0.93. Shock as an initial presentation (P = 0.039) and polymicrobial infection (P = 0.010) were significantly associated with poor outcome. There were no significant differences in the clinical or laboratory features of the patients who did or did not undergo nephrectomy. CONCLUSION: Hypoalbuminemia, shock as an initial presentation, bacteremia, indications for hemodialysis and polymicrobial infection represent prognostic factors for mortality in patients with emphysematous pyelonephritis. Patients presenting with more than two of these prognostic factors carry the highest risk of mortality, and they require timely diagnosis and aggressive management.


Assuntos
Enfisema/diagnóstico , Pielonefrite/diagnóstico , Enfisema/complicações , Enfisema/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pielonefrite/complicações , Pielonefrite/mortalidade , Estudos Retrospectivos
18.
Clin Microbiol Infect ; 20(10): O721-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24330047

RESUMO

In patients with community-onset acute pyelonephritis (CO-APN), assessing the risk factors for poor clinical response after 72 h of antibiotic treatment (early clinical failure) is important. The objectives of this study were to define those risk factors, and to assess whether early clinical failure influences mortality and treatment outcomes. We prospectively collected the clinical and microbiological data of women with CO-APN in South Korea from March 2010 to February 2012. The numbers of cases in the early clinical success and early clinical failure groups were 840 (79.1%) and 222 (20.9%), respectively. Final clinical failure and mortality were higher in the early clinical failure group than in the early clinical success group (14.9% vs 2.3%, p <0.001; 6.8% vs 0.1%, p 0.001, respectively). In a multiple logistic regression model, the risk factors for early clinical failure among the total 1062 patients were diabetes mellitus (OR 1.5; 95% CI 1.1-2.1), chronic liver diseases (OR 3.3; 95% CI 1.6-6.7), malignancy (OR 2.2; 95% CI 1.1-4.4), Pitt score ≥2 (OR 2.5; 95% CI 1.6-3.8), presence of azotaemia (OR 1.8; 95% CI 1.2-2.7), white blood cell count ≥20 000/mm(3) (OR 2.5; 95% CI 1.6-4.0), serum C-reactive protein level ≥20 mg/dL (OR 1.7; 95% CI 1.2-2.4), and history of antibiotic usage within the previous year (OR 1.5; 95% CI 1.1-2.2). Analysing the subgroup of 743 patients with CO-APN due to Enterobacteriaceae, fluoroquinolone resistance of the uropathogen was another factor associated with early clinical failure (OR 1.7; 95% CI 1.1-2.5). Simple variables of underlying diseases, previous antibiotic usage and initial laboratory test outcomes can be used to decide on the direction of treatment in CO-APN.


Assuntos
Antibacterianos/administração & dosagem , Pielonefrite/tratamento farmacológico , Pielonefrite/mortalidade , Adulto , Idoso , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , República da Coreia/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Falha de Tratamento
19.
Asian J Surg ; 36(3): 121-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23810162

RESUMO

OBJECTIVE: To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). METHODS: Case notes of patients with EPN were reviewed. The patients' demographic data, clinical presentation, investigation findings, treatment, and outcome were studied. RESULTS: Twelve patients were diagnosed with EPN. Majority (66.7%) of them had diabetes mellitus. All patients had been evaluated by computed tomography (CT). Using the classification proposed by Wan et al, five patients had type 1 EPN, whereas six, two, and four patients had Huang and Tseng CT class 2, 3a, and 3b EPN, respectively. Immediate nephrectomy was performed in six patients, whereas conservative treatment was adopted in the other six. In the nephrectomy group, one patient died of disseminated sepsis after a protracted course. Conservative treatment failed in three patients, who succumbed despite salvage nephrectomy in two of them. Analysis revealed that severe hyperglycemia and radiological CT class (both Wan and Huang systems) were significant predictors of mortality from EPN. CONCLUSION: Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.


Assuntos
Enfisema/etiologia , Pielonefrite/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Enfisema/diagnóstico por imagem , Enfisema/mortalidade , Enfisema/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pielonefrite/complicações , Pielonefrite/diagnóstico por imagem , Pielonefrite/mortalidade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Am J Emerg Med ; 31(7): 1092-7, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23702052

RESUMO

PURPOSE: Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED. METHODS: We conducted a prospective study of women with APN presenting to the ED. The authors measured inflammatory biomarkers, and the severity of pyelonephritis was assessed by 4 severity of disease classification system and stage of sepsis. We performed an analysis to assess the value of PCT for the prediction of 28-day mortality and disease severity. RESULTS: A total of 240 female patients with APN are included. Patients were divided into 4 groups on the basis of systemic inflammatory response syndrome criteria, organ dysfunction, and persistent hypotension. The median PCT level was higher in the septic shock group compared with other groups. Of the other inflammatory markers, only white blood cell count was significantly different among the groups, whereas high-sensitivity C-reactive protein level and erythrocyte sedimentation rate revealed no differences. The area under the curve for PCT in predicting 28-day mortality was 0.68. For predicting mortality, a cutoff value of 0.42 ng/mL had a sensitivity of 80% and a specificity of 50%. However, the disease classification systems were demonstrated to be superior to PCT in predicting 28-day mortality. CONCLUSIONS: Relative to other classic markers of inflammation, by distinguishing the severity of sepsis related to APN, PCT levels can provide additional aid to clinicians in disease severity classification and their decision of treatment at ED.


Assuntos
Calcitonina/sangue , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência , Precursores de Proteínas/sangue , Pielonefrite/diagnóstico , Índice de Gravidade de Doença , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Pielonefrite/sangue , Pielonefrite/complicações , Pielonefrite/mortalidade , Curva ROC , Sensibilidade e Especificidade , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/mortalidade
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