# Etiopathogenesis and Antibacterial Therapy Approach in Patients with Acute Obstructive Pyelonephritis—A Retrospective Study

## TL;DR

This study examines the causes, bacteria, and treatment of acute obstructive pyelonephritis in patients at a urology center.

## Contribution

The study provides insights into regional bacterial resistance patterns and treatment strategies for AOP.

## Key findings

- Urolithiasis was the most common cause of obstruction in AOP patients.
- Escherichia coli was the leading pathogen, with 18% being ESBL-producing and 29% MDR bacteria.
- Carbapenems were used for ESBL and MDR cases, with treatment duration based on clinical response.

## Abstract

Objectives: Acute obstructive pyelonephritis (AOP) is a urological emergency that combines bacterial infection with upper urinary tract obstruction. This retrospective study focuses on the microbial etiology and causes of obstruction, clinical manifestations, antibacterial therapy, drainage type, and outcomes in patients diagnosed with AOP at a tertiary urology center between 1 January 2020 and 30 December 2024. Methods: One hundred patients with a mean age of 61.30 years were included in this retrospective study, which examines demographic data, comorbidities, clinical features, pathogens involved, antimicrobial regimens, and hospital outcomes. Results: Urolithiasis was the most frequent cause of obstruction (62%), followed by ureteral stenosis (14%) and tumors (11%). AOPs were mainly produced by Escherichia coli (58%), followed by Klebsiella spp. (21%); 18% of all identified bacteria were ESBL-producing Gram-negative bacilli, and 29% were MDR bacteria. The most used IV antibiotics were fluoroquinolones (52%), followed by cephalosporins (19%) and carbapenems (18%). Carbapenems were administered to all patients with AOP caused by ESBL-producing pathogens and to 62% of those with MDR bacteria. The duration of antibiotic therapy was individualized based on clinical response. Switch to oral administration was made after 4.3 ± 1.5 days, and the antibiotic treatment lasted 10.8 ± 3.2 days. Conclusions: The results of the present study support integrating evidence-based guidelines with regional patterns of bacterial susceptibility to optimize therapeutic approaches and reduce severe outcomes in patients with AOP, most of whom have multiple comorbidities.