Korean J Intern Med.  2015 May;30(3):372-383. 10.3904/kjim.2015.30.3.372.

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

• Chang UI
• Kim HW
• Noh YS
• Wie SH

• KMID: 2160710
• DOI: http://doi.org/10.3904/kjim.2015.30.3.372

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.

Keyword

Pyelonephritis; Aged; Non-elderly; Enterobacteriaceae

MeSH Terms

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
Anti-Bacterial Agents