[Approach of renal parenchyma infection: retrospective study of period 2005-2007]

The renal parenchyma acute infection, known as acute pyelonephritis (APN), is diagnosed and treated in some Hospital Departments of the H.C.U. Lozano Blesa. We want to know if the process was made in a homogeneous way, fixed to the described quality standards and if we could detect improvement areas.

Retrospective study in admitted patients with the diagnosis of APN over and 2 year period (11-05/10-07), evaluating some variables referred to epidemiological data, diagnosis, treatment and evolution.

We studied 118 patients (80.5% women, mean age 34 years), that supposed 0.39% of patients admitted from the Emergency Department (36% in Urology and the rest in Paediatric, Obstetric, Internal Medicine and others).45% showed risk factors (urinary anomalies, diabetes, pregnancy, immunosuppressant, ...), and it is considered complicated APN (CAPN). In children there was a high rate of urinary tract malformations. Diagnosis was clinical in 82.2%. The rest required imaging techniques, specially children, using gamma scan. In 82.7% there was leukocyturia and in 79.9% leukocytosis. A urine culture pre-treatment was made in 76.3%, with a positive rate of 55.5%, detecting negative Gram germs in 94% (E. coli in 82%). Treatment was empiric in all cases, based on cephalosporin, amoxicillin/clavulanic acid and fluoroquinilones. Evolution was favorable in 93.1% (95.1% of NCAPN and 85.7% of CAPN). The mean hospital stay was 6.4 days (5.6 in NCAPN and 7.5 in CAPN).

Acute pyelonephritis management in our hospital is highly satisfactory and similar to the revised medical literature. We could emphasize the low rate of urinary cultures pretreatment (negative in quite a lot of the cases, due to early beginning of antibiotic treatment) and that mean hospital stay could be reduced in CAPN. We want to congratulate all involved professionals at the hospital for the good practice demonstrated.