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Open Access Highly Accessed Research article

Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis

Yu-Chuan Lu1, Bing-Juin Chiang1, Yuan-Hung Pong1, Kuo-How Huang1, Po-Ren Hsueh2, Chao-Yuan Huang1* and Yeong-Shiau Pu1

Author Affiliations

1 Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, 10002 No. 7 Chung-Shan South Road, Taipei, Taiwan

2 Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

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BMC Infectious Diseases 2014, 14:418  doi:10.1186/1471-2334-14-418

Published: 29 July 2014

Abstract

Background

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. Percutaneous drainage is now the gold standard of definitive management. The aim of this study is to analyze the predictors associated with failure of conservative treatment among patients with EPN and offer the recommendation of appropriate empirical antibiotic regimen.

Methods

From January 2001 to December 2013, 44 consecutive patients were diagnosed with EPN. The demographic characteristics, clinical presentations, management strategies, and final outcomes were analyzed retrospectively.

Results

The overall survival rate was 88.6% (39/44). Need for emergency hemodialysis, shock on initial presentation, altered mental status, severe hypoalbuminemia, inappropriate empirical antibiotic treatment and polymicrobial infections were significantly more common in the patients who died compared with the survivors. The overall failure rate of conservative treatment was 32.6% (14/43). Severe hypoalbuminemia (p = 0.003), need for emergency hemodialysis (p = 0.03), and polymicrobial infections (p = 0.04) were significantly associated with failure of conservative treatment. Severe hypoalbuminemia was independently associated with conservative management failure (p = 0.02). Even in the patients treated with percutaneous drainage plus effective antibiotics, failure was still associated with severe hypoalbuminemia (p = 0.01). According to the in vitro susceptibility data, third-generation cephalosporins is recommended as the empirical antibiotic regimen.

Conclusions

Both appropriate empirical antibiotic and percutaneous drainage were essential for patients with EPN. Patients with severe hypoalbuminemia had a higher risk of conservative treatment failure, and additional management may be required.

Keywords:
Emphysematous pyelonephritis; Percutaneous drainage; Conservative management; Severe hypoalbuminemia; Empirical antibiotic regimen