产超广谱β-内酰胺酶菌株在气肿性肾盂肾炎中的预后——来自大型多中心研究系列的结果
Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series.
作者信息
Robles-Torres José Iván, Castellani Daniele, Trujillo-Santamaría Hegel, Teoh Jeremy Yuen-Chun, Tanidir Yiloren, Campos-Salcedo José Gadú, Bravo-Castro Edgar Iván, Wroclawski Marcelo Langer, Kumar Santosh, Sanchez-Nuñez Juan Eduardo, Espinosa-Aznar José Enrique, Ragoori Deepak, Hamri Saeed Bin, Aik Ong Teng, Tarot-Chocooj Cecil Paul, Shrestha Anil, Amine Lakmichi Mohamed, Cosentino-Bellote Mateus, Vázquez-Lavista Luis Gabriel, Kabre Boukary, Tiong Ho Yee, Gómez-Guerra Lauro Salvador, Kutukoglu Umut, Alves-Barbosa Joao Arthur Brunhara, Jaspersen Jorge, Acevedo Christian, Virgen-Gutiérrez Francisco, Agrawal Sumit, Duarte-Santos Hugo Octaviano, Ann Chai Chu, Yeoh Wei Sien, Gauhar Vineet
机构信息
Department of Urology, Hospital Universitario "Dr. José Eleuterio Gonzalez", Monterrey 64460, Mexico.
Urology Unit, Azienda ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, 60126 Ancona, Italy.
出版信息
Pathogens. 2022 Nov 23;11(12):1397. doi: 10.3390/pathogens11121397.
BACKGROUND
Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different.
METHODS
A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality.
RESULTS
A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, = 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, = 0.019). Early nephrectomy (OR 2.3, = 0.029) and delayed nephrectomy (OR 2.4, = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, = 0.001).
CONCLUSIONS
ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.
背景
气肿性肾盂肾炎（EPN）是一种肾脏及周围组织的坏死性感染，死亡率较高。我们旨在评估有或无产超广谱β-内酰胺酶（ESBL）细菌的EPN患者的临床因素及其对预后的影响，并确定因ESBL感染导致EPN的患者预后是否有所不同。
方法
对来自11个国家22个中心（2013年至2020年）诊断为EPN的患者进行回顾性分析。评估人口统计学、临床表现、生化参数、影像学特征、微生物学特征和治疗管理情况。进行单变量和多变量分析以确定与ESBL病原体相关的独立变量。比较ESBL和非ESBL感染患者的死亡率，并评估治疗方式。
结果
共纳入570例患者。中位（四分位间距）年龄为57（47 - 65）岁。在尿培养中，最常见的分离病原体是[此处原文缺失具体病原体名称]（62.2%）。556份尿培养中有291份（52.3%）存在产ESBL病原体。在多变量分析中，血小板减少（比值比1.616，95%置信区间1.081 - 2.413，P = 0.019）和黄曾4型（比值比1.948，95%置信区间1.005 - 3.778，P = 0.048）是ESBL病原体的独立预测因素。黄曾量表1型患者产ESBL病原体的几率降低55%（比值比1.616，95%置信区间1.081 -
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