A COMPARATIVE STUDY OF ANTIMICROBIAL SENSITIVITY IN PATIENTS WITH ACUTE PYELONEPHRITIS AND EMPHYSEMATOUS PYELONEPHRITIS

Abstract

Background: Urinary tract infections (UTIs) commonly affect men and can lead to serious complications such as acute pyelonephritis (APN) and emphysematous pyelonephritis (EPN). APN typically impacts the renal pelvis and parenchyma, often exacerbated by conditions like obesity, diabetes, or immunosuppression. EPN, characterized by gas formation within the renal tissues, is predominantly caused by Escherichia coli and Klebsiella pneumoniae.

Objective: This study aims to identify the pathogens responsible for emphysematous pyelonephritis, compare their prevalence with acute pyelonephritis, and evaluate their antimicrobial sensitivity patterns.

Methods: A comparative study was conducted over twelve months, from July 2023 to June 2024, involving 145 patients diagnosed with APN and EPN at the Institute of Kidney Disease, Peshawar. Urine samples were collected and cultured to determine the causative microorganisms and assess their antibiotic sensitivities. Data analysis was performed using SPSS 23.

Results: Among the patients, 72.4% (n=105) were diagnosed with APN and 27.6% (n=40) with EPN. Escherichia coli was the most common pathogen in both conditions. Antimicrobial sensitivity testing showed high effectiveness of colistin (90.4%), amikacin (88.0%), piperacillin/tazobactam (82.4%), imipenem (82.4%), and gentamicin (82.4%) for APN. However, sensitivities were lower in EPN, reflecting a concerning rise in antimicrobial resistance.

Conclusion: The prevalence of antimicrobial resistance, especially in EPN cases, poses significant challenges. Although colistin, aminoglycosides, and carbapenems remain largely effective, their misuse is contributing to increased resistance. Adhering to WHO guidelines for antimicrobial prescriptions is critical to manage and prevent the escalation of multidrug resistance.