Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis

A multicenter study

Yeonjae Kim, Seong Heon Wie, U. Im Chang, Jieun Kim, Moran Ki, Young Kyun Cho, Seung Kwan Lim, Jin Seo Lee, Ki Tae Kwon, Hyuck Lee, Hee-Jin Cheong, Dae Won Park, Seong Yeol Ryu, Moon Hyun Chung, Hyunjoo Pai

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). Methods: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. Results: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P=0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P=0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P<0.001). However, more of them had C-reactive protein ≥20mg/dL (40.7% vs. 27.4% P<0.001), azotemia (29.3% vs. 13.4% P<0.001) and bacteremia (53.7% vs. 38.2% P<0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P=0.169; 2.0% vs. 1.7%, P=0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P<0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P=0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. Conclusions: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.

Original languageEnglish
Pages (from-to)244-251
Number of pages8
JournalJournal of Infection
Volume69
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1

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Pyelonephritis
Multicenter Studies
Azotemia
Hospitalization
Bacteremia
Flank Pain
Republic of Korea
Fluoroquinolones
Urinary Tract Infections
C-Reactive Protein
Nausea
Vomiting
Dementia
Logistic Models
Mortality

Keywords

  • Acute pyelonephritis
  • Diabetes mellitus
  • Women

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis : A multicenter study. / Kim, Yeonjae; Wie, Seong Heon; Chang, U. Im; Kim, Jieun; Ki, Moran; Cho, Young Kyun; Lim, Seung Kwan; Lee, Jin Seo; Kwon, Ki Tae; Lee, Hyuck; Cheong, Hee-Jin; Park, Dae Won; Ryu, Seong Yeol; Chung, Moon Hyun; Pai, Hyunjoo.

In: Journal of Infection, Vol. 69, No. 3, 01.01.2014, p. 244-251.

Research output: Contribution to journalArticle

Kim, Y, Wie, SH, Chang, UI, Kim, J, Ki, M, Cho, YK, Lim, SK, Lee, JS, Kwon, KT, Lee, H, Cheong, H-J, Park, DW, Ryu, SY, Chung, MH & Pai, H 2014, 'Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis: A multicenter study', Journal of Infection, vol. 69, no. 3, pp. 244-251. https://doi.org/10.1016/j.jinf.2014.05.002
Kim, Yeonjae ; Wie, Seong Heon ; Chang, U. Im ; Kim, Jieun ; Ki, Moran ; Cho, Young Kyun ; Lim, Seung Kwan ; Lee, Jin Seo ; Kwon, Ki Tae ; Lee, Hyuck ; Cheong, Hee-Jin ; Park, Dae Won ; Ryu, Seong Yeol ; Chung, Moon Hyun ; Pai, Hyunjoo. / Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis : A multicenter study. In: Journal of Infection. 2014 ; Vol. 69, No. 3. pp. 244-251.
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AU - Chang, U. Im

AU - Kim, Jieun

AU - Ki, Moran

AU - Cho, Young Kyun

AU - Lim, Seung Kwan

AU - Lee, Jin Seo

AU - Kwon, Ki Tae

AU - Lee, Hyuck

AU - Cheong, Hee-Jin

AU - Park, Dae Won

AU - Ryu, Seong Yeol

AU - Chung, Moon Hyun

AU - Pai, Hyunjoo

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N2 - Objectives: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). Methods: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. Results: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P=0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P=0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P<0.001). However, more of them had C-reactive protein ≥20mg/dL (40.7% vs. 27.4% P<0.001), azotemia (29.3% vs. 13.4% P<0.001) and bacteremia (53.7% vs. 38.2% P<0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P=0.169; 2.0% vs. 1.7%, P=0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P<0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P=0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. Conclusions: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.

AB - Objectives: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). Methods: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. Results: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P=0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P=0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P<0.001). However, more of them had C-reactive protein ≥20mg/dL (40.7% vs. 27.4% P<0.001), azotemia (29.3% vs. 13.4% P<0.001) and bacteremia (53.7% vs. 38.2% P<0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P=0.169; 2.0% vs. 1.7%, P=0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P<0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P=0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. Conclusions: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.

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