Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis: a multicenter study

Abstract

OBJECTIVES: 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 beta-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.