Klebsiella pneumoniae renal abscess.
BACKGROUND
The clinical characteristics of renal abscess caused by Klebsiella pneumoniae have not been previously reported in case-series studies. The purpose of this study is to demonstrate the clinical characteristics of K pneumoniae renal abscess for early diagnosis and to identify the clinical risk factors associating with poor prognosis.


METHODS
We retrospectively reviewed the medical records of 24 patients with K pneumoniae renal abscess, from April, 1982 through February, 1998. The clinical presentations, including the demographic characteristics, predisposing disorders, initial signs and symptoms, laboratory test results, diagnostic radiology studies, therapeutic modalities and risk factors associated with mortality were studied.


RESULTS
The mean age was 58.7 years and the male to female ratio was 10:14. The most common predisposing factors were diabetes mellitus (58%), urolithiasis (25%) and immunosuppression (17%). Fever, chills and flank pain were the most common symptoms and signs, whereas pyuria, elevation of leukocyte count, glucose, blood urea nitrogen and creatinine were the common laboratory features. The distinct complications of K pneumoniae renal abscess were bacteremia in 13 (54%), emphysematous pyelonephritis in five (21%), and metastatic septic infection in three (12.5%). The cure rate was 52% (11/21) in patients treated with a combination of antibiotics and percutaneous drainage; however, six (35%) patients who survived required another surgical procedure for complete recovery. The overall mortality rate was 25%. The clinical factors of elderly age (>65 years) at presentation, lethargy, elevation of serum blood urea nitrogen and pulmonary complications were associated with poor prognoses.


CONCLUSIONS
Focusing on the early diagnosis of K pneumoniae renal abscess and recognition of the prognostic factors for a poor prognosis, we highlight the specific clinical characteristics that include elderly age, lethargy, impairment of renal function, metastatic septic lesions and pulmonary complications. All patients with K pneumoniae renal abscesses should receive empiric antibiotics and percutaneous drainage or aspiration, and surgical intervention as necessary for patients with intractable disease.
Chang
S W
SW
Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
Yen
D H
DH
Fung
C P
CP
Liu
C Y
CY
Chen
K K
KK
Tiu
C M
CM
Wang
L M
LM
Lee
C H
CH
D000038:Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents