Yamamichi Fukashi, Shigemura Katsumi, Kitagawa Koichi, Fujisawa Masato
Department of Urology, Hara Genitourinary Hospital, 5-7-17, Kita-Nagasa-dori, Chuo-ku, Kobe, 650-0012, Japan.
Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Department of Infection Control and Prevention, Kobe University Hospital, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Division of Infectious Disease, Department of International Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka Suma-ku, Kobe, 654-0142, Japan.
J Infect Chemother. 2018 Nov;24(11):902-906. doi: 10.1016/j.jiac.2018.08.002. Epub 2018 Aug 30.
This study assessed risk factors for septic shock in patients with obstructive acute pyelonephritis (APN) associated with upper urinary tract calculi in a multi-center retrospective study.
We studied 143 patients admitted to 4 hospitals in Japan with obstructive APN associated with upper urinary tract calculi. Data on gender, age, hypertension, diabetes, neurological disease or malignant disease, laboratory data (white blood cell (WBC) and C-reactive protein (CRP)), drainage, and bacterial strains including Escherichia coli in the non-septic and septic groups were collected. Risk factors for septic shock were analyzed by univariate and multivariate statistical analyses.
There were a total of 107 non-septic cases (74.8%) and 36 septic cases (25.2%). The commonest strains of urinary tract infection-causative bacteria were E. coli in the non-septic group (23 cases, 21.5%) and septic group (13 cases, 36.1%) (p > 0.05). Emergency drainage was administered in 74.8% of the non-septic group and 97.2% of the septic group (p > 0.05). Meropenem was most often used as the initial treatment in the non-septic group (20 cases, 18.7%) and septic group (22 cases, 61.1%) (p < 0.0001). Risk factors for septic shock in multivariate analyses were diabetic mellitus (odds ratio (OR) = 3.591, p = 0.0098) and CRP ≥ 10 (OR = 1.057, p = 0.0119) as significant independent factors in this multicenter study.
APN is a common infectious disease, especially in the cases with urinary tract obstruction where patients easily acquire bacteremia or sepsis. Stone-associated obstructed APN can cause fatal septic shock in cases with diabetes and CRP ≥ 10. Further prospective studies will be undertaken to draw definitive conclusions.
本多中心回顾性研究评估了伴有上尿路结石的梗阻性急性肾盂肾炎（APN）患者发生感染性休克的危险因素。
我们研究了日本4家医院收治的143例伴有上尿路结石的梗阻性APN患者。收集了非感染性和感染性休克组患者的性别、年龄、高血压、糖尿病、神经疾病或恶性疾病、实验室数据（白细胞（WBC）和C反应蛋白（CRP））、引流情况以及包括大肠杆菌在内的细菌菌株的数据。通过单因素和多因素统计分析来分析感染性休克的危险因素。
共有107例非感染性病例（74.8%）和36例感染性病例（25.2%）。非感染性组（23例，21.5%）和感染性组（13例，36.1%）中引起尿路感染的最常见细菌菌株均为大肠杆菌（p>0.05）。非感染性组74.8%的患者和感染性组97.2%的患者接受了紧急引流（p>0.05）。美罗培南在非感染性组（20例，18.7%）和感染性组（22例，61.1%）中最常被用作初始治疗药物（p<0.0001）。在这项多中心研究中，多因素分析显示感染性休克的危险因素为糖尿病（比值比（OR）=3.591，p=0.0098）和CRP≥10（OR=1.057，p=0.0119），它们是显著的独立因素。
APN是一种常见的传染病，尤其是在尿路梗阻的情况下，患者容易发生菌血症或败血症。伴有结石的梗阻性APN在糖尿病患者且CRP≥10时可导致致命的感染性休克。将开展进一步的前瞻性研究以得出明确结论。
