title: Clinical features and prognostic factors of emphysematous urinary tract infection.
abstract: OBJECTIVE
  Emphysematous urinary tract infection (EUTI) is a rare and potentially life-threatening condition that requires prompt evaluation and management. This study was conducted to ascertain the clinical features and prognostic factors of EUTI.
  
  
  METHODS
  Patients diagnosed with EUTI radiologically and treated at the Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, from March 2001 to February 2007 were evaluated. The patients' demographic and clinical characteristics, laboratory data, treatment, and outcomes were analyzed retrospectively.
  
  
  RESULTS
  Of 31 patients enrolled, 16 had emphysematous pyelonephritis (EP) and 15 had emphysematous cystitis (EC) classified according to the imaging findings. The symptoms and signs of fever, chills, flank pain, and percussion tenderness at the costovertebral angle were significantly greater among patients in the EP group than in the EC group (p = 0.029, p = 0.009, p < 0.001, and p < 0.001, respectively). There were no statistically significant differences in the initial laboratory data except for C-reactive protein between the 2 groups (220.4 microg/mL vs 91.4 microg/mL; p = 0.001). Escherichia coli was the most commonly isolated organism. The overall mortality rate was similar in both groups. Significant differences in renal function and hematuria were seen between the patients who died and the survivors in the EP group (p = 0.004 and p = 0.027, respectively), but these were not noted in the EC group.
  
  
  CONCLUSIONS
  There was no significant clinical feature suggesting the presence of EC. The clinical features of EP were similar to uncomplicated pyelonephritis. Impaired renal function and hematuria were poor prognostic factors for patients with EP, but not for patients with EC.
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Kuo
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.forename: Wei-Ru
authors.initials: WR
authors.lastname: Lin
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Jih-Jin
authors.initials: JJ
authors.lastname: Tsai
authors.forename: Ko
authors.initials: K
authors.lastname: Chang
authors.forename: Hsiao-Cheng
authors.initials: HC
authors.lastname: Hsieh
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D005260:Female; D006417:Hematuria / Q000473:pathology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency; D012189:Retrospective Studies; D013624:Taiwan; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*
chemical_list: D015415:Biomarkers