THE EFFECT OF DIABETES MELLITUS ON THE CLINICAL AND MICRO-BIOLOGICAL OUTCOMES IN PATIENTS WITH ACUTE PYELONEPHRITIS

Abstract

There is some published evidence which suggests that the clinical outcomes and pathogens associated with Acute Pyelonephritis (AP) differ between diabetics and non-diabetics. However, current guidelines do not make treatment distinctions based on Diabetes Mellitus (DM) status. The objectives of this study were to identify the microbiological and clinical characteristics of hospitalized patients with AP and investigate differences between patients with and without DM. A retrospective cohort study of adult patients admitted with AP at The Brooklyn Hospital Center was conducted. Patient information was accessed through the hospital’s electronic medical record system and patients were identified through primary discharge diagnosis ICD-9 codes for AP within the past three years. Patients were then screened for DM; all DM patients were randomly matched in a 2:1 manner to patients without DM admitted with AP during the same time period. A total of 48 patients were included in this analysis, 16 with DM and 32 without DM. There was a significantly greater median length of stay among diabetics (6 (3-8) Vs. 3 days (2-5), P = 0.02). There was a greater rate of antimicrobial resistance among DM patients, with a significantly greater rate of infection by Multi-Drug Resistant Organisms (MDRO) (4/16 [25%] Vs. 1/32 [3%], P = 0.036). Escherichia coli was the overall most common uropathogen, in 50% of the DM patients and 53% of the non-DM patients. Ceftriaxone monotherapy was the most commonly used empiric regimen in both groups (10/16 [63%] Vs. 19/32 [59%]) and there were similar rates of ceftriaxone sensitivity (8/10 [80%] Vs. 19/19 [100%]). Patients with DM were at greater risk of infection from MDRO and required longer lengths of hospitalization than patients without DM. Further investigation is warranted to guide effective empiric treatment of AP among patients with DM.