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Volume 42, Number 5, October 2009

Clinical features and prognostic factors of emphysematous urinary tract infection


Cheng-Yu Kuo, Chun-Yu Lin, Tun-Chieh Chen, Wei-Ru Lin, Po-Liang Lu, Jih-Jin Tsai, Ko Chang, Hsiao-Cheng Hsieh, Yeh-Hsu Chen


Received: May 1, 2008    Revised: July 17, 2008    Accepted: August 8, 2008   

 

Corresponding author:

Wei-Ru Lin, 100 Tzyou 1st Rd, Kaohsiung 807 Taiwan, Email: lwru@mail2000.com.tw



 

Background and purpose: 

Emphysematous urinarytract infection (EUTI)is a rare and potentially life-threatening condiction that requires prompt evaluation and management. This study was conducted to ascertain the clinical features and prognostic factors of EUTI.



 

Methods:

Patients diagnosed with EUTI radiologically and treated at the Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, from March 2001 to February 2007 were evaluated. The patients' demographic and clinical characterstics, laboratory data, treatment and outcomes were analyzed retrospectively.



 

Results:

Of 31 patients enrolled, 16 had emphysematous pyelonephritis (EP) and 15 had emphysematous cystitis (EC) classified according to the imaging findings.The symptoms and signs of fever, chills, flank pain, and percussion tendemess at the costovertebral angle were significantly greater among patients in the EP group than inthe EC group (p=0.029, P=0.009, P<0.001, and P<0.001, respectively). There were no statistically significant differences in the initial laboratory data except for C-reactive protein between the 2 groups (220.4 ug/mL vs 91.4 ug/mL; p=0.001). Escherichia coli was the mostcommoly isolatedorganism. The overall mortality rate was similar in bothgroups. Significant differences in renal function and hematuria were seen between the patients who died and the survivors in theEP group (p=0.004 and p=0.027, respectively), but these were not noted in the EC group.



 

Conclusion:

There was no significant clinial feature suggesting the presence of EC. The clinical features of EP were similar to uncomplicated pyelonephritis. Impaired renal function and hematuria were poor prognostic factors for patients withEP, but not for patients with EC.



 

Key words:

Cystitis; Prognosis; Pyelonephritis; Urinary tract infections