عنوان

To assess epidemiological study, clinical, radiological, laboratory findings, associated factors, treatment methods, duration of admission and treatment outcome in patients with emphysematous urinary tract infection referred to Imam Khomeini and Shariati Hospital in year 2015-2020,بررسی اپیدمیولوژیک، بالینی، رادیولوژیک،یافته های آزمایشگاهی، عوامل مرتبط، روش های درمان، مدت بستری و نتیجه درمان در بیماران مبتلا به عفونت آمفیزماتوز دستگاه ادراری مراجعه کننده به بیمارستان امام خمینی و شریعتی در سال ۱۳۹۵-۱۴۰۰

Number

98132P

.Language of Text, Soundtrack etc

انگلیسی

Title Proper

To assess epidemiological study, clinical, radiological, laboratory findings, associated factors, treatment methods, duration of admission and treatment outcome in patients with emphysematous urinary tract infection referred to Imam Khomeini and Shariati Hospital in year 2015-2020

Title Proper

بررسی اپیدمیولوژیک، بالینی، رادیولوژیک،یافته های آزمایشگاهی، عوامل مرتبط، روش های درمان، مدت بستری و نتیجه درمان در بیماران مبتلا به عفونت آمفیزماتوز دستگاه ادراری مراجعه کننده به بیمارستان امام خمینی و شریعتی در سال ۱۳۹۵-۱۴۰۰

General Material Designation

[Dissertation]

First Statement of Responsibility

Bushra Fatema Alehasan

First Statement of Responsibility

بشری فاطمه آل حسن

Name of Publisher, Distributor, etc.

Tehran University of Medical Sciences, Faculty of Medicine

Date of Publication, Distribution, etc.

2022

Specific Material Designation and Extent of Item

53p

Dissertation or thesis details and type of degree

Doctor Of Medicin(MD)

Date of degree

2022/07/17

Text of Note

TITLE:To assess epidemiological study, clinical, radiological, laboratory findings, associated factors, treatment methods, duration of admission and treatment outcome in patients with emphysematous urinary tract infection referred to Imam Khomeini and Shariati Hospital in year 2015-2020.INTRODUCTION: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in hospital outcomes of patients with EPN. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20–40% in the contemporary meta-analysis. The term emphysematous pyelonephritis was coined by Schultz and Klorfein in 1962, although Kelly and McCallum reported the first case of EPN in 1898. EPN requires special attention due to the life threatening complications, especially sepsis. EPN is commonly associated with diabetes mellitus especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Escherichia coli is the most commonly encountered organism, others being- Klebsiella, Proteus, Pseudo- monas, Clostridium, Streptococcus, Candida, Aspergillus and Cryptococcus species and sometimes polymicrobial infections. The pathogenesis of EPN is multi-factorial. This study included patients with emphysematous infections of the urinary tract during 5 years from 2015 to 2020 referred to Imam Khomeini and Shariati Hospital and collection of demographic information, risk factors, clinical manifestations, paraclinical features including Complete blood count differential (CBCdiff), Erythrocyte Sedimentation Rate (ESR), C- reactive protein (CRP), Blood Culture (B/C), Urinalysis (U/A), Urine Culture (U/C). Imaging features include ultrasound findings or CT scans. The type of intervention performed is medical and surgical (nephrostomy, double J, nephrectomy, etc.) and the length of the patient's hospital stay (outcome of patients includes discharge or mortality). METHODS: Our method is a cross sectional retrospective study in which we studied patient files including all medical records and lab data of patients diagnosed with emphysematous urinary tract infections referred to Imam Khomeini and Shariati Hospital Tehran from year 2015-2020.RESULTS:All patients were managed with supportive care and medical management with drainage procedure such as JJ stenting and percutaneous nephrostomy or nephrectomy, were discharged with just one mortality among total 47 patients of emphysematous pyelonephritis or cystitis in Imam Khomeini and Shariati Hospital.CONCLUSIONS:Patients with risk factor of diabetes mellitus and a preponderance of female over male was reported, the high level of blood glucose may provide gas forming microorganisms with a more favorable environment for gas formation here in our study the most common microorganism was E.coli and then Klebsiella like other studies. The duration of admission of patients with emphysematous pyelonephritis or cystitis in Imam Khomieni and Shariati hospital was with a minimum of 7 to maximum of 25 days. In our report the mean age of patients involved was 54.2 yrs with a female preponderance (61.7%) which reports that more commonly elderly women with multiple comorbidities such as diabetes mellitus type 2 more commonly, renal stones, surgeries and immunocompetetent(cancer) patients were more commonly associated to emphysematous pyelonephritis or cystitis. Our study depicted the overall site of involvement of disease in patients with kidney 91.1% and with 12.8% only bladder involvement. According to Huang JJ classification of CT-scan in diagnosing the disease the most patients in our study were seen in class 1 (46.8%) CT-scan classification followed by class 3A (17.0%) and then class 2 CT-scan classification with 14.9%. Treatment with one of antimicrobial therapies such as piperacillin and tazobactum or carbapenem used in our management course as together with insertion of double j and nephrectomy done in a majority of patients showed good response in recovery and most of them also were managed only with antimicrobial therapy alone.The mean duration of admission in hospital in our study was 19.2 days, with a minimum of 3 days and maximum of 45 days.The outcome of these patients admitted due to emphysematous pyelonephritis or cystitis in Imam Khomeini and Shariati hospital was that throughout the admission in hospital only 1 patientexpired due to septic shock and poor response to medical and surgical management, the mortality rate among EPN patients according to our study was 2% as the rest 46 patients in our study taken were discharged after attaining partial to full recovery. Within the limitations of a small sample size in our study, we conclude that the timely diagnosis and specific antibiotic treatment avoided the need for surgery and reduced the risk of mortality.

Entry Element

Diabetes Mellitus, Type 2 [1]

Emphysematous urinary tract infections

renal stones

CT scan classification

سنگ کلیه

عفونت های آمفیزماتوز دستگاه ادراری

دیابت شیرین

سی تی اسکن

Relator Code

, Author

Relator Code

, Author

Fatema Alehasan, Bushra

فاطمه الحسن، بشری

Relator Code

, Thesis advisor

Relator Code

, Thesis advisor

Relator Code

, Consulting advisor

Relator Code

, Consulting advisor

Relator Code

, Consulting advisor

Relator Code

, Consulting advisor

Ghaderkhani, Sara

قادرخانی، سارا

Salehi, Mohammad Reza

صالحی، محمدرضا

Meidani, Mohsen

میدانی، محسن

Entry Element

Tehran University of Medical Sciences, Faculty of Medicine

Country

ایران

Date of Transaction

20220904

Call Number

409 pardis

Electronic name

p

TL

276903

a

Y