Department of Nephrology, Jupiter Hospital, Mumbai, Maharashtra, India.
Department of Nephrology, Medanta- The Medicity, Gurgaon, Haryana, India.
Saudi J Kidney Dis Transpl. 2021 Jan-Feb;32(1):209-217. doi: 10.4103/1319-2442.318526.
A wide range of causative organisms can cause acute pyelonephritis (APN). However, in recent times, these pathogens have increasingly become resistant to most of the antibiotics making treatment difficult. This was a prospective observational single-center study with a aim to study the microbiological spectrum, resistance patterns, and clinical outcome of patients with APN conducted in a private tertiary care hospital in India. All adult patients hospitalized in the department of nephrology at our institute with a diagnosis of APN from February 2016 to May 2017 were included. Patients <18 years of age, kidney-transplant recipients, and pregnant patients were excluded. Demographic details, clinical symptoms, signs, and radiological and laboratory data including urine and blood cultures of all patients were recorded. The details of treatment received and outcomes in hospital and after discharge were noted. Patients were followed up three months post discharge. Decision of antibiotic and duration of antibiotics was documented by treating nephrologists. Quantitative data were presented in terms of means and standard deviation. Student's "t" test was used for comparison of quantitative outcome parameters. P <0.05 is considered statistically significant. SPSS software version 23.0 was used for statistical analysis. A total of 89 patients with a mean age of 50.33 ± 13.9 years, of which 61.8% were males and were studied; 82/89 had complicated pyelonephritis. The most common risk factor for APN was diabetes mellitus in 64 (72%). Most common symptom was fever in 80 (90%). A triad of fever, flank pain, and dysuria was present only in 27 (30.33%). Overall, 15 patients (16.8%) had severe pyelonephritis requiring intensive care unit admission. The most common organism isolated was Escherichia coli in 26/49 (53%), followed by Klebsiella pneumoniae in 12 (24.40%). Twenty-two (58%) isolates were extended-spectrum beta lactamase producers. Six (12.20%) were resistant to carbapenems and two (4%) were pan-resistant. All 89 were treated with intravenous antibiotics. Older patients, those with diabetes, with poor glycemic control, and with emphysematous pyelonephritis and patients in whom ESBL organisms were grown had poor outcome. Piperacillin tazobactam, aminopenicillins, cefoperazone sulbactam, and carbapenems (in severe pyelonephritis) can be considered as the empirical antibiotic of choice.
急性肾盂肾炎（APN）可由多种病原体引起。然而，近年来，这些病原体对大多数抗生素的耐药性日益增加，导致治疗变得困难。这是一项在印度一家私立三级护理医院进行的前瞻性观察性单中心研究，旨在研究 APN 患者的微生物谱、耐药模式和临床结果。
纳入 2016 年 2 月至 2017 年 5 月在我院肾病科住院、诊断为 APN 的所有成年患者。排除年龄<18 岁、肾移植受者和孕妇。记录所有患者的人口统计学资料、临床症状、体征以及尿液和血液培养的放射学和实验室数据。记录患者在院和出院后的治疗和结局。患者出院后随访 3 个月。抗生素的选择和抗生素的使用时间由治疗肾病的医生记录。定量数据以均值和标准差表示。采用学生“t”检验比较定量结果参数。P<0.05 为统计学显著。使用 SPSS 软件版本 23.0 进行统计分析。
共研究了 89 例患者，平均年龄为 50.33±13.9 岁，其中 61.8%为男性；82/89 例为复杂性肾盂肾炎。APN 的最常见危险因素是糖尿病，共 64 例（72%）。最常见的症状是发热，共 80 例（90%）。仅有 27 例（30.33%）存在发热、腰痛和尿痛三联征。总体而言，15 例（16.8%）患者因严重肾盂肾炎需要入住重症监护病房。
最常见的病原体是 26 株（53%）大肠埃希菌，其次是 12 株（24.40%）肺炎克雷伯菌。22 株（58%）分离株为产超广谱β-内酰胺酶。6 株（12.20%）对碳青霉烯类耐药，2 株（4%）为全耐药。89 例患者均接受静脉抗生素治疗。年龄较大、合并糖尿病、血糖控制不佳、合并气肿性肾盂肾炎以及产 ESBL 菌的患者预后较差。哌拉西林他唑巴坦、氨芐西林、头孢哌酮舒巴坦和碳青霉烯类（严重肾盂肾炎时）可作为经验性抗生素的选择。
