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

Objective: To determine the pathogens responsible for emphysematous pyelonephritis and compare it with acute pyelonephritis and their antimicrobial sensitivity patterns in these patients. Methodology: A twelve-month prospective comparative observational study from July 2023 to June 2024, was conducted on 145 patients diagnosed with either acute pyelonephritis or EPN at the Institute of Kidney Disease, Peshawar. The patients over 18 years of age with a clinical diagnosis of acute or emphysematous pyelonephritis and a positive urine culture were included. Exclusion criteria included recent antibiotic use (within 14 days), pregnancy, chronic kidney disease, congenital urogenital anomalies, immunocompromised states, and incomplete patient data. Urine samples were cultured to identify causative microbes and assess their antibiotic sensitivity. The results were analyzed using SPSS 23. Results: Among 145 patients, 72.4% had acute pyelonephritis and 27.6% had EPN. E. coli was the predominant pathogen in both conditions (64.8% in APN vs 60.0% in EPN, p=0.632). In acute pyelonephritis, highest sensitivity was observed for colistin (96.5%), amikacin (93.1%), and imipenem (93.1%). However, in EPN cases, sensitivity to these antibiotics was significantly lower (p=<0.01): colistin (76.3%), amikacin (76.3%), and imipenem (57.9%). Conclusion: The study highlights a concerning rise in antimicrobial resistance, particularly in EPN cases. Colistin, aminoglycosides, and carbapenems remain effective, but potentially contributing to the resistance of these drugs. Adherence to WHO guidelines for antimicrobial prescription is essential to combat multidrug resistance.