Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis: a multicenter study.
OBJECTIVE
Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN).


METHODS
We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012.


RESULTS
Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P = 0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P = 0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P < 0.001). However, more of them had C-reactive protein ≥20 mg/dL (40.7% vs. 27.4% P < 0.001), azotemia (29.3% vs. 13.4% P < 0.001) and bacteremia (53.7% vs. 38.2% P < 0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P = 0.169; 2.0% vs. 1.7%, P = 0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P < 0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P = 0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens.


CONCLUSIONS
CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
Yeonjae
Y
Kim
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea.
Seong-Heon
SH
Wie
Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea.
U-Im
UI
Chang
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
Jieun
J
Kim
College of Medicine, Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea.
Moran
M
Ki
Gil Hospital, Gacheon University, Incheon, South Korea.
Young Kyun
YK
Cho
Ajou University Hospital, Suwon, South Korea.
Seung-Kwan
SK
Lim
Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
Jin Seo
JS
Lee
Daegu Fatima Hospital, Daegu, South Korea.
Ki Tae
KT
Kwon
Dong-A University Hospital, Busan, South Korea.
Hyuck
H
Lee
Korea University Guro Hospital, Seoul, South Korea.
Hee Jin
HJ
Cheong
Korea University Ansan Hospital, Ansan, South Korea.
Dae Won
DW
Park
Gyemyeong University Hospital, Daegu, South Korea.
Seong Yeol
SY
Ryu
Inha University Hospital, Incheon, South Korea.
Moon-Hyun
MH
Chung
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea. Electronic address: paihj@hanyang.ac.kr.
Hyunjoo
H
Pai
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism; D017714:Community-Acquired Infections / Q000382:microbiology; D003920:Diabetes Mellitus / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D005260:Female; D021501:Flank Pain / Q000382:microbiology; D006801:Humans; D007710:Klebsiella Infections; D007902:Length of Stay; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections; D011704:Pyelonephritis / Q000150:complications / Q000382:microbiology*; D013203:Staphylococcal Infections; D014552:Urinary Tract Infections / Q000382:microbiology*
D002097:C-Reactive Protein
Acute pyelonephritis; Diabetes mellitus; Women