Study of Clinical, Laboratory Profile, and Outcome of Patients with Acute Pyelonephritis in a Tertiary Care Hospital

Abstract

Aims: This study aims to study the clinical profile of patients with acute pyelonephritis (APN), yield of urine culture in APN; common causative agents and their antibiotic sensitivity pattern and to study the outcome of patients with APN in terms of mortality, duration of hospital stay, need of intensive care unit (ICU) care and necessitation of urological intervention. Materials and Methods: This study was a prospective observational study of patients who were admitted to the Postgraduate Department of General Medicine, Shri Maharaja Hari-Singh Hospital, an associated hospital of Government Medical College Srinagar as clinically suspected cases of APN and then proven radiologically. The study was conducted over a period of 2 years from August 2018 to August 2020 and a total of 200 patients fulfilling the selection criteria were included in the study. Results: Classical triad of fever, dysuria, and flank pain was seen in 55% of our patients with fever as the predominant symptom seen in 92% of patients. In our study, 70% were diabetic, 11% had nephrolithiasis, 8% of patients had obstructive uropathy, 7% were immunosuppressed, 3% had indwelling catheters while as 9% were documented cases of chronic kidney disease. Out of all positive urine cultures, 60% were Escherichia coli, 16.6 were Enterococcus, 13.3% were klebsiella, and 10% were Pseudomonas. Conclusion: Fever is predominant symptom in APN 23. Diabetes is the most common underlying predisposing condition. Yield of urine culture is very low with E. coli is the predominant organism. USG has less sensitivity for diagnosing APN than CT. The outcome of patients in terms of duration of hospital stay and need of ICU care is poor in diabetic patients. In our study, USG underestimated the cases of APN; detected only 132 out of 184 cases of computed tomography-proven nonemphysematous pyelonephritis and only 8 out of 16 patients of emphysematous pyelonephritis with an overall sensitivity of 70%. In our study, 3% of patients needed ICU care while 46% and 4% develop acute kidney injury and multiple organ dysfunction syndromes, respectively. Eleven percent of patients required urological intervention. Unfortunately, 2 out of 200 patients died during disease in the hospital.