Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series

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.

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References

Castillo-Tokumori F, Irey-Salgado C, Malaga G . Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case-control study. Int J Infect Dis. 2016; 55:16-19. DOI: 10.1016/j.ijid.2016.12.007. View

Misgar R, Mubarik I, Wani A, Bashir M, Ramzan M, Laway B . Emphysematous pyelonephritis: A 10-year experience with 26 cases. Indian J Endocrinol Metab. 2016; 20(4):475-80. PMC: 4911836. DOI: 10.4103/2230-8210.183475. View

Garcia-Tello A, Gimbernat H, Redondo C, Arana D, Cacho J, Angulo J . Extended-spectrum beta-lactamases in urinary tract infections caused by Enterobacteria: understanding and guidelines for action. Actas Urol Esp. 2014; 38(10):678-84. DOI: 10.1016/j.acuro.2014.05.004. View

Briongos-Figuero L, Gomez-Traveso T, Bachiller-Luque P, Dominguez-Gil Gonzalez M, Gomez-Nieto A, Palacios-Martin T . Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract. 2012; 66(9):891-6. DOI: 10.1111/j.1742-1241.2012.02991.x. View

Jain A, Manikandan R, Dorairajan L, Sreenivasan S, Bokka S . Emphysematous pyelonephritis: Does a standard management algorithm and a prognostic scoring model optimize patient outcomes?. Urol Ann. 2019; 11(4):414-420. PMC: 6798304. DOI: 10.4103/UA.UA_17_19. View

Gutierrez-Gutierrez B, Rodriguez-Bano J . Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect. 2019; 25(8):932-942. DOI: 10.1016/j.cmi.2019.03.030. View

Wan Y, Lo S, Bullard M, Chang P, Lee T . Predictors of outcome in emphysematous pyelonephritis. J Urol. 1998; 159(2):369-73. DOI: 10.1016/s0022-5347(01)63919-3. View

Robles-Torres J, Ocana-Munguia M, Arrambide-Herrera J, Martinez-Fernandez A, Romero-Mata R, Gomez-Guerra L . What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?. Asian J Urol. 2022; 9(2):146-151. PMC: 9051347. DOI: 10.1016/j.ajur.2021.04.012. View

Shaikh S, Fatima J, Shakil S, Danish Rizvi S, Kamal M . Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi J Biol Sci. 2015; 22(1):90-101. PMC: 4281622. DOI: 10.1016/j.sjbs.2014.08.002. View

10.

Trujillo-Santamaria H, Robles-Torres J, Teoh J, Tanidir Y, Campos-Salcedo J, Bravo-Castro E . A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group. Curr Urol. 2024; 18(1):55-60. PMC: 10946659. DOI: 10.1097/CU9.0000000000000163. View

11.

Arrambide-Herrera J, Robles-Torres J, Ocana-Munguia M, Romero-Mata R, Gutierrez-Gonzalez A, Gomez-Guerra L . Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital. Actas Urol Esp (Engl Ed). 2022; 46(2):98-105. DOI: 10.1016/j.acuroe.2021.01.010. View

12.

Lu Y, Hong J, Chiang B, Pong Y, Hsueh P, Huang C . Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center. Medicine (Baltimore). 2016; 95(21):e3573. PMC: 4902344. DOI: 10.1097/MD.0000000000003573. View

13.

Pontin A, Barnes R . Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009; 6(5):272-9. DOI: 10.1038/nrurol.2009.51. View

14.

Ubee S, McGlynn L, Fordham M . Emphysematous pyelonephritis. BJU Int. 2010; 107(9):1474-8. DOI: 10.1111/j.1464-410X.2010.09660.x. View

15.

Harris P, Tambyah P, Lye D, Mo Y, Lee T, Yilmaz M . Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial. JAMA. 2018; 320(10):984-994. PMC: 6143100. DOI: 10.1001/jama.2018.12163. View

16.

Somani B, Nabi G, Thorpe P, Hussey J, Cook J, Ndow J . Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008; 179(5):1844-9. DOI: 10.1016/j.juro.2008.01.019. View

17.

Krishnamoorthy S, Zumla A, Sekar H, Muneer A, Thiruvengadam G, Kumaresan N . Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11-year prospective study at a tertiary referral centre. BJU Int. 2020; 127(4):418-427. DOI: 10.1111/bju.15225. View