Emphysematous Urinary Tract Infections in Regional Australia: Retrospective Review of Risk Factors, Microbiology, Management and Outcomes from 38 Cases

Abstract

Emphysematous urinary tract infections (EUTI) are a dangerous and rare complication of urinary tract infection. Recent advances in management have reduced mortality and need for emergency nephrectomy. However, there remains a paucity of data concerning this condition in a regional Australian setting, despite a high observed incidence at our institution. We aimed to evaluate the risk factors, microbiological profile, clinical management, and outcomes of emphysematous urinary infections in our center. A retrospective review of all patients diagnosed with EUTI in a single regional hospital over a 5-year period in rural Australia. Thirty-eight cases of EUTI were identified. Diabetes (76%) and female gender (79%) were common risk factors. E. coli was the most common organism (n = 26; 68%), followed by K. pneumoniae (n = 5; 13%). About 62% of patients were indigenous or Torres Strait Islander, and 55% were from a rural or remote locality. About 52% of patients required acute surgical intervention, 16% required admission to the intensive care unit (ICU). All patients were managed with a nephron-sparing approach and none required nephrectomy, with only a single EUTI-related mortality encountered. There was a high rate of antimicrobial resistance encountered (76%) with extended spectrum beta-lactamase-producing E. coli identified in 15% of patients. Our retrospective study of EUTI provides the first Australian data regarding this rare disease, particularly in a regional setting. Despite high rates of antimicrobial resistance, a low mortality rate was achieved using a nephron-sparing approach.