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. 2022 Nov 23;11(12):1397.
doi: 10.3390/pathogens11121397.

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series

José Iván Robles-Torres  1 , Daniele Castellani  2 , Hegel Trujillo-Santamaría  3 , Jeremy Yuen-Chun Teoh  4 , Yiloren Tanidir  5 , José Gadú Campos-Salcedo  6 , Edgar Iván Bravo-Castro  6 , Marcelo Langer Wroclawski  7   8 , Santosh Kumar  9 , Juan Eduardo Sanchez-Nuñez  10 , José Enrique Espinosa-Aznar  11 , Deepak Ragoori  12 , Saeed Bin Hamri  13 , Ong Teng Aik  14 , Cecil Paul Tarot-Chocooj  15 , Anil Shrestha  16 , Mohamed Amine Lakmichi  17 , Mateus Cosentino-Bellote  18 , Luis Gabriel Vázquez-Lavista  19 , Boukary Kabre  20 , Ho Yee Tiong  21 , Lauro Salvador Gómez-Guerra  3 , Umut Kutukoglu  5 , Joao Arthur Brunhara Alves-Barbosa  22 , Jorge Jaspersen  10 , Christian Acevedo  10 , Francisco Virgen-Gutiérrez  10 , Sumit Agrawal  23 , Hugo Octaviano Duarte-Santos  24 , Chai Chu Ann  14 , Wei Sien Yeoh  21 , Vineet Gauhar  25
Affiliations

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series

José Iván Robles-Torres et al. Pathogens. .

Abstract

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different.

Methods: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality.

Results: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001).

Conclusions: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

Keywords: emphysematous pyelonephritis; extended-spectrum beta-lactamases; minimally invasive procedures; nephrectomy; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

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