Kang Shih-Chao, Tsao Hsuan-Ming, Liu Chien-Ting, Perng Chin-Lin, Hwang Shinn-Jang
Division of Family Medicine, I-Lan Hospital, Department of Health, Yilan, Taiwan, ROC.
Tohoku J Exp Med. 2008 Jan;214(1):61-7. doi: 10.1620/tjem.214.61.
Acute pyelonephritis causes hospitalization and is a commonly-ignored cause of death in geriatric patients. It has been well studied in young-adult populations but rarely in geriatric populations. The aim of our study was to analyze the characteristics of acute pyelonephritis in geriatric patients. The electronic admission records of a community hospital in northeastern Taiwan were retrospectively screened from July 1, 2003 to June 30, 2006. The basic characteristics, laboratory findings and infectious microorganisms of all subjects were evaluated. Sixty-five subjects (mean age 71.6 +/- 4.9 years; range 65-84 years) and 73 admission records contributed by them were enrolled. These 65 subjects, including one who died in hospital, were predominantly female (52 subjects; 80%). Twenty-two subjects (33.8%) had co-existing diabetes mellitus, 9 subjects (13.8%) had co-existing tumors, and 19 subjects (29.2%) had a history of intra-abdominal surgery. The admission records revealed right kidney involvement (52.1%), co-existing urolithiasis (50.7%) and admission to wards of internal medicine (57.5%). Urological procedures were performed on 20 (27.4%) of all 73 admission records. Escherichia coli was the most common infecting microorganism (19.2% of all records; 42.4% of records with positive microorganism culture). Hemoglobin < 10 g/dl was a significant predictive factor for both hospital stay > 7 days and serum creatinine > 2.0 mg/dl (p = 0.003 and 0.002, respectively). Positive microorganism culture was also a significant predictive factor for hospital stays > 7 days (p < 0.001). In our geriatric patients with acute pyelonephritis, low hemoglobin levels implied co-existing renal insufficiency and prolonged hospitalization. Positive microorganism culture also implied prolonged hospitalization.
急性肾盂肾炎会导致住院治疗，且是老年患者中一个常被忽视的死亡原因。它在年轻成人人群中已有充分研究，但在老年人群中却很少被研究。我们研究的目的是分析老年患者急性肾盂肾炎的特征。回顾性筛查了台湾东北部一家社区医院2003年7月1日至2006年6月30日的电子入院记录。评估了所有受试者的基本特征、实验室检查结果和感染微生物。纳入了65名受试者（平均年龄71.6±4.9岁；范围65 - 84岁）及其提供的73份入院记录。这65名受试者中，包括1名在医院死亡的患者，以女性为主（52名受试者；80%）。22名受试者（33.8%）患有糖尿病，9名受试者（13.8%）患有肿瘤，19名受试者（29.2%）有腹部手术史。入院记录显示右肾受累（52.1%）、合并尿路结石（50.7%）以及入住内科病房（57.5%）。73份入院记录中有20份（27.4%）进行了泌尿外科手术。大肠杆菌是最常见的感染微生物（占所有记录的19.2%；在微生物培养阳性的记录中占42.4%）。血红蛋白<10 g/dl是住院时间>7天和血清肌酐>2.0 mg/dl的显著预测因素（分别为p = 0.003和0.002）。微生物培养阳性也是住院时间>7天的显著预测因素（p < 0.001）。在我们的老年急性肾盂肾炎患者中，低血红蛋白水平意味着存在肾功能不全和住院时间延长。微生物培养阳性也意味着住院时间延长。
