Publication: Clinical presentation, microbiological characteristics, and their implications for perioperative outcomes in xanthogranulomatous pyelonephritis: perspectives from a real-world multicenter practice
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Date
2023-05-10
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Abstract
Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous
infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due
to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles
from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients
with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively
reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total
of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in
34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture
was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients,
respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in
both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures
(6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases
producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis,
urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal
and pararenal space were independent factors associated with positive bladder urine cultures. On
multivariable analysis, only the presence of anemia was significantly more frequent in patients
with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing
nephrectomy.
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Keywords
xanthogranulomatous pyelonephritis, urine culture, microbiology, urinary pathogens, prognosis
Citation
Gauhar V., Robles-Torres J. I., Wroclawski M. L., Trujillo-Santamaría H., Teoh J. Y. C., Tanidir Y., Mahajan A., Gadzhiev N., Ragoori D., Kumar S., et al., "Clinical Presentation, Microbiological Characteristics, and Their Implications for Perioperative Outcomes in Xanthogranulomatous Pyelonephritis: Perspectives from a Real-World Multicenter Practice.", Pathogens (Basel, Switzerland), cilt.12, sa.5, 2023