A Study of Microbiological Profile in patients with Acute Pyelonephritis in a Tertiary Care Hospital, Nandyal

Background : Acute pyelonephritis is a bacterial infection thataffects the renal parenchyma that can be life-threatening andoften leads to renal scarring. It usually ascended from the lowerurinary tract, and also reach the kidney via the bloodstream.Early diagnosis and management of acute pyelonephritis havea better impact on patient outcomes. Acute pyelonephritis isone of the severe conditions with high mortality and morbidity.It represents the most severe form of urinary tract infection.Acute pyelonephritis is the most common cause of communityonset bacteremia in elderly patients1.Aim: To study the microbiological profile in patients with acutepyelonephritis admitted in a tertiary care hospital.Materials and Methods: A Hospital-based Prospective studywas conducted in the Department of Medicine, Santhirammedical college & general hospital for a 2 year period.UniversalSampling Technique was used for the selection of studysubjects.The study population included patients admitted withfever, flank pain, and positive urine or blood cultures in thedepartment of general medicine in Santhiram medical collegeand general hospital.The final sample size was 50 subjects.Results: In the present study, 50 participants were selected asthe study population. The mean age of the study populationwas 57.48 ± 11.21. The majority of participants (70%) weredistributed in a 50 to 69-year age group. Majority ofparticipants were females (60%) and males (40%).In the currentstudy among participants, in the current study, urine culturewas positive in 29 patients (58%) of the study population. In29(58%) of the subjects who had a culture-positive infection,the most predominant infectious agent in the present studygroup was Escherichia. coli and was reported in 22 (44%) ofthe study subjects. Other causative organisms include,Klebsiella pneumonia was reported in 2(4%) subjects. Candidaalbicans, Citrobacter, Enterococcus faecalis, and Pseudomonaswere isolated in 1 (2%) subject each. One subject had a dualinfection with Escherichia coli and Candida.In current study,among the 29 culture isolates, none of them were resistant toCefperazone plus Sulbactum or Piperacillin plus tazobactam.The highest proportion of resistance was reported forAmpicillin as 82.1% of isolates were resistant. Levofloxacinresistance was found in 67.9% of isolates. Gentamicin andAmikacin resistance was found 17.86% and 3.6% of the isolates.Nitrofurantoin resistance was found in 2 (7.1%) of isolates.Conclusion: The mean age of the study population was 57.480± 11.2072 years in the study population, and there was a slightfemale preponderance in the occurrence of APN.The majorityof participants (78%) were distributed ina 50 to 69-year agegroup.Diabetes, hypertension, ureteric calculus, and pasthistory of UTI were the common risk factors identified in thestudy population.In.More than half (58%) of the studypopulation had a culture-positiveinfection.TheThe mostcommon organism isolated in the study population was E.Coli,responsible for 44% of the cases. None of them were resistantto Cefoperazone plus Sulbactum or Piperacillin plustazobactam. The other antimicrobials, which have not shownany resistance, were Meropenem and Colistin.The highestproportion of resistance was reported for Ampicillin in 82.1%,followed by Levofloxacin in 67.9% of isolates. ICU admissionrate was higher in culture-positive cases (63.6%), as comparedto culture-negative cases (36.4%)None of the study subjectshad hospital mortality