Retrospective Comparison of Clinical Characteristics and In-Hospital Outcomes among Diabetic and Non-Diabetic Adults with Acute Pyelonephritis

Abstract

Introduction: Acute Pyelonephritis (APN) is a common infection in community. Diabetes Mellitus (DM) may have different effect on clinical characteristics and outcomes of APN compared to non-diabetic individuals. Aim: To compare clinical characteristics and assess outcomes of APN patients with and without DM. Materials and Methods: A retrospective analysis of 122 patients with DM (n=61) and without DM (n=61) was conducted at a single, private, urban set-up from Gujarat, India. Clinical symptoms, laboratory investigations, antibiotics treatment and outcomes in terms of mortality and prolonged hospitalization (10 days and above) were compared in two groups. Results: Mean age was significantly higher in diabetics than non-diabetics (55.2±12.5 vs 41.5±17.3, p 5/ high power field [hpf]) did not vary significantly in two groups. Cephalosporin-beta-lactamase inhibitor (CefaperazoneSulbactam/Cefepime-Tazobactam) was the most prescribed antibiotic in both the groups. No deaths were observed in any group during this evaluation period. Only raised ESR (>30 mm/ hr) {Odds Ratio (OR): 1.58, 95% Confidence Interval (CI) 1.36- 1.82, p=0.004} and presence of CKD (OR: 1.71, 95% CI 1.30- 2.25, p=0.008) were found to be the significant predictors of prolonged hospitalization in overall population. Conclusion: APN in diabetic and non-diabetic patients has similar clinical characteristics. Impact of diabetes on clinical outcomes of mortality and prolonged hospitalization warrants further investigation in a large, randomized, prospective trial.

Keywords

• chronic kidney disease
• prolonged hospitalization
• risk predictors