Gopinath Kango Gopal1, Benny Paul Wilson2, Surekha Viggeswarpu3, Sowmya Sathyendra4, Ramya Iyyadurai5, Renuka Visvanathan6, Kuruvilla Prasad Mathews7. 1. Associate Professor, Department of Geriatrics, CMC , Vellore, India . 2. Assistant Professor, Department of Geriatrics, CMC , Vellore, India . 3. Professor, Department of Geriatrics, CMC , Vellore, India . 4. Professor, Department of Internal Medicine Unit 3, CMC , Vellore, India . 5. Associate Professor, Department of Internal Medicine Unit 5, CMC , Vellore, India . 6. Director, Aged and Extended care services, The Queen Elizabeth Hospital , Woodville South Australia 5011 . 7. Professor and Head, Department of Geriatrics, CMC , Vellore, India .
Abstract
BACKGROUND: Pyelonephritis is a serious infection associated with significant morbidity and mortality in the elderly with an estimated annual incidence rate of around 10% from previous studies. Older people are at a higher risk for pyelonephritis due to multiple factors including structural, functional and co-existent conditions. There is very little data on the incidence, clinical features and outcomes among elderly patients with pyelonephritis in India. MATERIALS AND METHODS: We performed a retrospective review of case records of 100 consecutive patients over the age of 60 years with pyelonephritis admitted to a tertiary care hospital. RESULTS: One fourth of our patients (26%) did not have fever, 49% had delirium and 52% had systemic inflammatory response syndrome (SIRS). Sixty five percent of the patients were diabetic and 60% had infections caused by extended spectrum beta lactamase (ESBL) producing organisms. As in other studies, the commonest organism isolated was E.coli (49%). A low serum albumin level was a predictor of mortality (p<0.001) and increased length of hospital stay (p<0.005). Delirium was also associated with a poor outcome (p=0.009) in these patients. Patients with pyelonephritis secondary to ESBL producing organisms had a higher length of stay (p<0.005). CONCLUSION: Hypoalbuminemia and delirium predicted poor outcomes in our patients. We found a high prevalence of ESBL infections in this study. Further research is required to assess the efficacy of aggressive management of delirium and low albumin in improving health and cost outcomes.
BACKGROUND:Pyelonephritis is a serious infection associated with significant morbidity and mortality in the elderly with an estimated annual incidence rate of around 10% from previous studies. Older people are at a higher risk for pyelonephritis due to multiple factors including structural, functional and co-existent conditions. There is very little data on the incidence, clinical features and outcomes among elderly patients with pyelonephritis in India. MATERIALS AND METHODS: We performed a retrospective review of case records of 100 consecutive patients over the age of 60 years with pyelonephritis admitted to a tertiary care hospital. RESULTS: One fourth of our patients (26%) did not have fever, 49% had delirium and 52% had systemic inflammatory response syndrome (SIRS). Sixty five percent of the patients were diabetic and 60% had infections caused by extended spectrum beta lactamase (ESBL) producing organisms. As in other studies, the commonest organism isolated was E.coli (49%). A low serum albumin level was a predictor of mortality (p<0.001) and increased length of hospital stay (p<0.005). Delirium was also associated with a poor outcome (p=0.009) in these patients. Patients with pyelonephritis secondary to ESBL producing organisms had a higher length of stay (p<0.005). CONCLUSION:Hypoalbuminemia and delirium predicted poor outcomes in our patients. We found a high prevalence of ESBL infections in this study. Further research is required to assess the efficacy of aggressive management of delirium and low albumin in improving health and cost outcomes.