Comparison of the clinical characteristics of diabetic and non-diabetic women with community-acquired acute pyelonephritis: A multicenter study

Objectives: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). Methods: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. Results: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P=0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P=0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P<0.001). However, more of them had C-reactive protein ≥20mg/dL (40.7% vs. 27.4% P<0.001), azotemia (29.3% vs. 13.4% P<0.001) and bacteremia (53.7% vs. 38.2% P<0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P=0.169; 2.0% vs. 1.7%, P=0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P<0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P=0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. Conclusions: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.