A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis.
10.3904/kjim.2015.30.3.372
- Author:
U Im CHANG
1
;
Hyung Wook KIM
;
Yong Sun NOH
;
Seong Heon WIE
Author Information
1. Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. wiesh@chol.com
- Publication Type:Original Article ; Comparative Study ; Research Support, Non-U.S. Gov't
- Keywords:
Pyelonephritis;
Aged;
Non-elderly;
Enterobacteriaceae
- MeSH:
Acute Disease;
Adult;
Age Factors;
Aged;
Anti-Bacterial Agents/therapeutic use;
Community-Acquired Infections/*diagnosis/drug therapy/microbiology;
Electronic Health Records;
Enterobacteriaceae Infections/*diagnosis/drug therapy/microbiology;
Female;
Hospitalization;
Hospitals, University;
Humans;
Middle Aged;
Pyelonephritis/*diagnosis/drug therapy/microbiology;
Remission Induction;
Republic of Korea;
Retrospective Studies;
Risk Factors;
Sex Factors;
Time Factors;
Treatment Outcome;
Urinary Tract Infections/*diagnosis/drug therapy/microbiology
- From:The Korean Journal of Internal Medicine
2015;30(3):372-383
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. METHODS: Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. RESULTS: Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level > or = 15 mg/dL, and patients with a leukocyte count > or = 15,000/mm3 in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). CONCLUSIONS: Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.
