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Krishnamoorthy S, Thiruvengadam G, Sekar H, Palaniyandi V, Ramadurai S, Narayanasamy S. Modified National Early Warning Score 2, a reliable early warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis. World J Nephrol 2025; 14:103035. [DOI: 10.5527/wjn.v14.i2.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 02/21/2025] [Accepted: 03/04/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection, predominantly affecting diabetic and immunocompromised patients. It carries high morbidity and mortality, requiring early diagnosis and timely intervention. Various prognostic scoring systems help in triaging critically ill patients. The National Early Warning Score 2 (NEWS 2) scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters, but its standard form lacks specificity for risk stratification in EPN, necessitating modifications to improve treatment decision-making and prognostic accuracy in this critical condition.
AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.
METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years. A weighted average risk-stratification index was calculated for each of the three groups, mortality risk was calculated for each of the NEWS 2 scores, and the need for intervention for each of the three groups was calculated. The NEWS 2 score was subsequently modified with 0-6, 7-14 and 15-20 scores included in groups 1, 2 and 3, respectively.
RESULTS A total of 171 patients with EPN were included in the study, with a predominant association with diabetes (90.6%) and a female-to-male ratio of 1.5:1. The combined prognostic scoring of the three groups was 10.7, 13.0, and 21.9, respectively (P < 0.01). All patients managed conservatively belonged to group 1 (P < 0.01). Eight patients underwent early nephrectomy, with six from group 3 (P < 0.01). Overall mortality was 8 (4.7%), with seven from group 3 (87.5%). The cutoff NEWS 2 score for mortality was identified to be 15, with a sensitivity of 87.5%, specificity of 96.9%, and an overall accuracy rate of 96.5%. The area under the curve to predict mortality based on the NEWS 2 score was 0.98, with a confidence interval of (0.97, 1.0) and P < 0.001.
CONCLUSION Modified NEWS 2 (mNEWS 2) score dramatically aids in the appropriate assessment of treatment-related outcomes. MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
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Affiliation(s)
- Sriram Krishnamoorthy
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Gayathri Thiruvengadam
- Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Hariharasudhan Sekar
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Velmurugan Palaniyandi
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Srinivasan Ramadurai
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Senthil Narayanasamy
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
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Shibata Y, Hirose M, Kondo S, Asai N, Hagihara M, Mikamo H. Can enterobacterales bacteremia with pyelonephritis be treated with ceftriaxone? J Infect Chemother 2025; 31:102696. [PMID: 40216245 DOI: 10.1016/j.jiac.2025.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 04/02/2025] [Accepted: 04/04/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Ceftriaxone (CTRX) is the antibiotic of choice for treating urinary tract infections (UTIs). However, CTRX has a lower urinary excretion rate than other β-lactam antibiotics. In 2023, Japan had a shortage of cefotiam (CTM), increasing the demand for CTRX for patients with UTIs. This study compared the efficacy of CTRX and other β-lactam antibiotics for Enterobacterales bacteremia and pyelonephritis. METHODS Patients with Escherichia coli, Klebsiella spp, or Proteus spp in blood and urine cultures treated with β-lactam antibiotics at Aichi Medical University Hospital between July 2014 and February 2024 were retrospectively recruited. Overall, 123 patients were included in the study and divided into two groups based on the type of antibiotic treatment: CTRX main group (CTRX for ≥5 days) and other β-lactam main group (ampicillin, cefazoline, CTM, or cefotaxime for ≥5 days). Patients were propensity score-matched by age, Charlson comorbidity index, duration of intravenous antibiotic treatment, number of patients who switched to oral antibiotics, albumin levels, white blood cell count, C-reactive protein, body temperature, and need for intensive care unit admission. The primary outcomes were treatment side effects, outcomes, and mortality at 30 and 90 days. RESULTS After propensity score matching, 26 patients were selected from each group. The all-cause 30-day mortality rate was 3.8 % in both groups. None of our patients experienced reinfections or rehospitalization for pyelonephritis. CONCLUSIONS CTRX treatment did not affect the prognosis of patients with Enterobacterales bacteremia and pyelonephritis. Therefore, avoiding using CTRX for UTIs because of lower urinary excretion rates may be unnecessary.
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Affiliation(s)
- Yuichi Shibata
- Department of Infection Prevention and Control, Aichi Medical University Hospital, Nagakute, Aichi, Japan; Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Marisa Hirose
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Shiori Kondo
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Nobuhiro Asai
- Department of Infection Prevention and Control, Aichi Medical University Hospital, Nagakute, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Infection Prevention and Control, Aichi Medical University Hospital, Nagakute, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
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Baba K, Ito K, Oki R, Furuya Y, Magari T, Ogura H, Kurosawa I. Impacts of clinical backgrounds and intervention strategies on duration of intravenous antibiotics treatments in patients diagnosed with calculous pyelonephritis: A single-center retrospective study. J Infect Chemother 2025; 31:102559. [PMID: 39542358 DOI: 10.1016/j.jiac.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 11/08/2024] [Accepted: 11/10/2024] [Indexed: 11/17/2024]
Abstract
OBJECTIVES There are limited information that need to do appropriate treatment including duration of antibiotic treatments, timing of urinary drainage and pathogenesis of bacteria in calculous pyelonephritis. In the present study, we investigated real-world data on clinical features and succeeded treatment strategies in calculous pyelonephritis cases in our hospital, then, aimed to make predictive model estimating duration of intravenous antibiotics treatment. METHODS Participants were 163 consecutive patients diagnosed with calculous pyelonephritis who underwent antibiotics treatments between 2017 and 2023 in our in-patients' clinic. Candidates for explanatory variables that may affect duration of antibiotic treatments were age, gender, body mass index, stone location, stone size, septic status, blood culture, urine drainage, indwelling urethral catheter, diabetes mellitus and steroid intake. RESULTS Duration of intravenous antibiotics treatment was 6 days in median (IQR: 4-8 days). Indwelling DJ stent or percutaneous nephrostomy were undergone in 74 (45.4 %) patients. Multiple regression analysis revealed that gender, age, indwelling urethral catheter, septic status and management of urine drainage independently affected essential duration of intravenous antibiotics treatment and regression coefficient estimates of those factors respectively were 0.998, 0.890, 2.487, 1.462, 1.293 with constant of 2.464. CONCLUSIONS Our preliminary multiple regression models for predicting duration of intravenous antibiotics treatment may be useful to judge the timing of changing treatment strategies for patients who would not improve at around estimated intravenous antibiotics treatment periods. If vital signs were stable, it may be acceptable to judge urine drainage from above the urinary stone at around two days after intravenous antibiotic treatments.
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Affiliation(s)
- Kyoko Baba
- Department of Urology, Kurosawa Hospital, Japan.
| | - Kazuto Ito
- Department of Urology, Kurosawa Hospital, Japan
| | - Ryo Oki
- Department of Urology, Kurosawa Hospital, Japan
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Nelson Z, Tarik Aslan A, Beahm NP, Blyth M, Cappiello M, Casaus D, Dominguez F, Egbert S, Hanretty A, Khadem T, Olney K, Abdul-Azim A, Aggrey G, Anderson DT, Barosa M, Bosco M, Chahine EB, Chowdhury S, Christensen A, de Lima Corvino D, Fitzpatrick M, Fleece M, Footer B, Fox E, Ghanem B, Hamilton F, Hayes J, Jegorovic B, Jent P, Jimenez-Juarez RN, Joseph A, Kang M, Kludjian G, Kurz S, Lee RA, Lee TC, Li T, Maraolo AE, Maximos M, McDonald EG, Mehta D, Moore JW, Nguyen CT, Papan C, Ravindra A, Spellberg B, Taylor R, Thumann A, Tong SYC, Veve M, Wilson J, Yassin A, Zafonte V, Mena Lora AJ. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2024; 7:e2444495. [PMID: 39495518 DOI: 10.1001/jamanetworkopen.2024.44495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2024] Open
Abstract
Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. Objective To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength. Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches. Findings A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation. Conclusions and Relevance In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
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Affiliation(s)
- Zachary Nelson
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | - Abdullah Tarik Aslan
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Susan Egbert
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Tina Khadem
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katie Olney
- University of Kentucky Healthcare, Lexington
| | - Ahmed Abdul-Azim
- Rutgers Health Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | - Mariana Barosa
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | | | - Alyssa Christensen
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | | | | | | | | | - Emily Fox
- UT Southwestern MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Boris Jegorovic
- Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorovic", Belgrade, Serbia
| | - Philipp Jent
- Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Annie Joseph
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Minji Kang
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Sarah Kurz
- University of Michigan Medical School, Ann Arbor
| | | | - Todd C Lee
- McGill University, Montreal, Quebec, Canada
| | - Timothy Li
- The Chinese University of Hong Kong, Hong Kong, China
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Italy
| | - Mira Maximos
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | | | - Dhara Mehta
- Bellevue Hospital Center, Manhattan, New York, New York
| | | | | | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | | | - Brad Spellberg
- Los Angeles General Medical Center, Los Angeles, California
| | - Robert Taylor
- Newfoundland and Labrador Health Services, St John's, Newfoundland & Labrador, Canada
- Memorial University, St. John's, Newfoundland & Labrador, Canada
| | | | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michael Veve
- Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - James Wilson
- Rush University Medical Center, Chicago, Illinois
| | - Arsheena Yassin
- Rutgers Health Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Yu J, Sri-Ganeshan M, Smit DV, Mitra B. Ultrasound for acute pyelonephritis: a systematic review and meta-analysis. Intern Med J 2024; 54:1106-1118. [PMID: 38339768 DOI: 10.1111/imj.16347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN). AIMS The aims of this systematic review were to, among patients with APN, (i) identify the proportion of patients investigated with ultrasound (US), (ii) identify the proportion of abnormal US and (iii) identify the proportion of patients with a change in management resulting from abnormal US. METHODS A comprehensive search covered two electronic databases (Medline and EMBASE), with selection of studies performed independently by two investigators. Inclusion criteria were English language APN diagnosis and quantification of patients assessed with US or abnormal US results. Quality appraisal used the Newcastle-Ottawa instrument. RESULTS There were 35 studies included. The proportion of patients assessed with US was reported in 16 manuscripts and ranged from 20% to 94%, with significant heterogeneity and publication bias. The proportion of abnormal US was reported in 31 manuscripts and ranged from 7% to 79%. The proportion of abnormal US leading to change in management was reported in five studies and ranged from 7% to 59%. There was marked heterogeneity among studies included in all three subgroups. CONCLUSIONS Patients with APN are commonly investigated with US, but only a small proportion have abnormalities and appear to be associated with changes in clinical management. The use of routine US for APN is therefore questioned. The identification of clinical variables for appropriate selection of patients to investigate with US requires further research.
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Affiliation(s)
- Jessica Yu
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Muhuntha Sri-Ganeshan
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Vanolli K, Jost ML, Clerc O, Genné D, John G. Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection. Infect Dis Rep 2024; 16:189-199. [PMID: 38525762 PMCID: PMC10961809 DOI: 10.3390/idr16020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59-77%) and 64% (95%CI: 54-73%) of them were adequately managed according to Van Nieuwkoop's clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33-61%) and 57% (95%CI: 44-69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0-46.5), gross haematuria (OR = 5.9; 95%CI: 1.6-22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8-18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop's rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.
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Affiliation(s)
- Katia Vanolli
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
| | - Mike Libasse Jost
- Department of Internal Medicine, Bienne Hospital Center, Chante-Merle 84, CH-2501 Bienne, Switzerland (D.G.)
| | - Olivier Clerc
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
| | - Daniel Genné
- Department of Internal Medicine, Bienne Hospital Center, Chante-Merle 84, CH-2501 Bienne, Switzerland (D.G.)
- Department of Medicine, Geneva University, Michel-Servet 1, CH-1206 Geneva, Switzerland
| | - Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
- Department of Medicine, Geneva University, Michel-Servet 1, CH-1206 Geneva, Switzerland
- Department of Internal Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205 Geneva, Switzerland
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Madrazo M, López-Cruz I, Piles L, Artero S, Alberola J, Aguilera JA, Eiros JM, Artero A. Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection. Microorganisms 2023; 11:1995. [PMID: 37630555 PMCID: PMC10459913 DOI: 10.3390/microorganisms11081995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1-1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2-39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2-24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3-18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7-10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.
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Affiliation(s)
- Manuel Madrazo
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
| | - Ian López-Cruz
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
| | - Laura Piles
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
| | - Silvia Artero
- Gregorio Marañón University Hospital, 28007 Madrid, Spain;
| | - Juan Alberola
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
| | - Juan Alberto Aguilera
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
| | - José María Eiros
- Rio Hortega University Hospital, Universidad de Valladolid, 47012 Valladolid, Spain;
| | - Arturo Artero
- Doctor Peset University Hospital, University of Valencia, 46017 Valencia, Spain; (M.M.); (I.L.-C.); (L.P.); (J.A.A.); (A.A.)
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Jacob A, Sahni RD, Bharathy M, George T, Rebekah G, Sudarsanam TD. Clinical features, outcomes and predictors of drug resistance and complications in patients admitted with pyelonephritis. Trop Doct 2023; 53:104-108. [PMID: 36164678 DOI: 10.1177/00494755221125627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug resistance and the presence of structural complications have significant implications for the treatment of acute pyelonephritis. We aimed to examine the predictors of drug resistance and complications in a retrospective cohort of patients admitted with pyelonephritis. 188 patients were included in this study. Patients who had had a urinary catheterization in the previous month and who lived outside the district in which the hospital was located were more likely to have ESBL infections. Carbapenem resistance was associated with recent urinary catheterization, a positive urine nitrate test, hypotension requiring vasopressors and the need for intensive care. A history of flank pain, urea level >13.3 mmol/L, a differential neutrophil count >75% and a urinalysis with >1000 leucocytes per high power field was associated with an increased risk of complications. A score derived from these variables to predict structural complications of infection had a sensitivity of 77.8% and a specificity of 67.1.
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Affiliation(s)
- Amita Jacob
- Department of Medicine, 30025Christian Medical College, Vellore, Tamil Nadu, India
| | - Rani Diana Sahni
- Department of Microbiology, 30025Christian Medical College, Vellore, Tamil Nadu, India
| | - Muruga Bharathy
- Department of Medicine, 30025Christian Medical College, Vellore, Tamil Nadu, India
| | - Tina George
- Department of Medicine, 30025Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, 30025Christian Medical College, Vellore, Tamil Nadu, India
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Smith AD, Nikolaidis P, Khatri G, Chong ST, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Kwun R, Lyshchik A, Nicola R, Purysko AS, Savage SJ, Taffel MT, Yoo DC, Delaney EW, Lockhart ME. ACR Appropriateness Criteria® Acute Pyelonephritis: 2022 Update. J Am Coll Radiol 2022; 19:S224-S239. [PMID: 36436954 DOI: 10.1016/j.jacr.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Acute pyelonephritis (APN) is a severe urinary tract infection (UTI) that has the potential to cause sepsis, shock, and death. In the majority of patients, uncomplicated APN is diagnosed clinically and is responsive to treatment with appropriate antibiotics. In patients who are high risk or when treatment is delayed, microabscesses may coalesce to form an acute renal abscess. High-risk patients include those with a prior history of pyelonephritis, lack of response to therapy for lower UTI or for APN, diabetes, anatomic or congenital abnormalities of the urinary system, infections by treatment-resistant organisms, nosocomial infection, urolithiasis, renal obstruction, prior renal surgery, advanced age, pregnancy, renal transplant recipients, and immunosuppressed or immunocompromised patients. Pregnant patients and patients with renal transplants on immunosuppression are at an elevated risk of severe complications. Imaging studies are often requested to aid with the diagnosis, identify precipitating factors, and differentiate lower UTI from renal parenchymal involvement, particularly in high-risk individuals. Imaging is usually not appropriate for the first-time presentation of suspected APN in an uncomplicated patient. The primary imaging modalities used in high-risk patients with suspected APN are CT, MRI, and ultrasound, although CT was usually not appropriate for initial imaging in a pregnant patient with no other complications. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama.
| | - Paul Nikolaidis
- Vice-Chair, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gaurav Khatri
- UT Southwestern Medical Center, Dallas, Texas; Chief, Division of Body MRI; Interim Chief, Division of Abdominal Imaging; Program Director, Body MRI Fellowship
| | - Suzanne T Chong
- Indiana University, Indianapolis, Indiana; Committee on Emergency Radiology-General, Small, Emergency and/or Rural Practice
| | | | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Richard Kwun
- Swedish Medical Center, Issaquah, Washington; American College of Emergency Physicians
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | - Andrei S Purysko
- Cleveland Clinic, Cleveland, Ohio; ACR Learning Network, Prostate MR Image Quality Improvement Collaborative, Physician Leader
| | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association; Professor and Vice Chairman of Urology
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York; Associate Section of Body Imaging
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Commission on Nuclear Medicine and Molecular Imaging
| | - Erin W Delaney
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Primary care physician
| | - Mark E Lockhart
- University of Alabama at Birmingham, Birmingham, Alabama; Chair UAB Department Appointments, Promotions, and Tenure Committee
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10
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Yano T, Takada T, Fujiishi R, Fujii K, Honjo H, Miyajima M, Takeshima T, Hayashi M, Miyashita J, Azuma T, Fukuhara S. Usefulness of computed tomography in the diagnosis of acute pyelonephritis in older patients suspected of infection with unknown focus. Acta Radiol 2022; 63:268-277. [PMID: 33508952 DOI: 10.1177/0284185120988817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs. PURPOSE To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus. MATERIAL AND METHODS This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel. RESULTS Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively. CONCLUSION CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.
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Affiliation(s)
- Tetsuhiro Yano
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Graduate School of Medicine, Fukushima Medical University. Fukushima City, Fukushima, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuto Fujiishi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Kotaro Fujii
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Hiroshi Honjo
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Masayuki Miyajima
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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11
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Cheong T, Ahn J, Kim YS, Pai H, Kim B. Quantitative Evaluation of the Economic Impact of Antimicrobial Resistance on the Treatment of Community-Acquired Acute Pyelonephritis in Korea. Infect Chemother 2022; 54:456-469. [PMID: 36047300 PMCID: PMC9533169 DOI: 10.3947/ic.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Materials and Methods Results Conclusion
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Affiliation(s)
- Taul Cheong
- Department of Economics, Indiana University Purdue University Indianapolis, Indianapolis, USA
| | - Jungmo Ahn
- School of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yun Seop Kim
- The Office of Research Strategy, Korea University Medical Center, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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12
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Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much? Antibiotics (Basel) 2021; 10:antibiotics10121493. [PMID: 34943705 PMCID: PMC8698875 DOI: 10.3390/antibiotics10121493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.
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13
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Giannella M, Malosso P, Scudeller L, Bussini L, Rebuffi C, Gatti M, Bartoletti M, Ianniruberto S, Pancaldi L, Pascale R, Tedeschi S, Viale P, Paul M. Quality of care indicators in the MAnageMent of BlOOdstream infections caused by Enterobacteriaceae (MAMBOO-E study): state of the art and research agenda. Int J Antimicrob Agents 2021; 57:106320. [PMID: 33716177 DOI: 10.1016/j.ijantimicag.2021.106320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The impact on outcome of five interventions was reviewed in order to investigate the state of the art for management of Enterobacteriaceae bloodstream infection (E-BSI). METHODS We searched for randomised controlled trials (RCTs) and observational studies published from January 2008 to March 2019 in PubMed, EMBASE and Cochrane Library. Populations consisted of patients with E-BSI. Interventions were as follows: (i) performance of imaging to assess BSI source and/or complications; (ii) follow-up blood cultures (FU-BCs); (iii) use of loading dose followed by extended/continuous infusion (E/CI) of β-lactams; (iv) duration of treatment (short- versus long-term); and (v) infectious diseases (ID) consultation. Patients without intervention were considered as controls. The main outcome was 30-day mortality. RoB 2.0 and ROBINS-I tools were used for bias assessment. RESULTS No study was eligible for interventions i, iii and v. For FU-BCs, one observational study including 901 patients with E-BSI was considered. Intervention consisted of repeating BCs within 2-7 days after index BCs. All-cause 30-day mortality was 14.2% (35/247) in the intervention group versus 14.7% (96/654) in the control group. For short treatment duration, two RCTs and six observational studies were included comprising 4473 patients with E-BSI. All-cause mortality was similar in the short and long treatment groups (OR = 1.10, 95% CI 0.83-1.44). CONCLUSION Of the assessed interventions, only short treatment duration in non-immunocompromised patients with E-BSI is supported by current data. Studies investigating the use of systematic imaging, FU-BCs, E/CI β-lactams and ID consultation in patients with E-BSI are needed.
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Affiliation(s)
- Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Pietro Malosso
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Luigia Scudeller
- Clinical Trials Team, Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Linda Bussini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Chiara Rebuffi
- Scientific documentation center - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Milo Gatti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Stefano Ianniruberto
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Livia Pancaldi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
| | - Sara Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Mical Paul
- Infectious Diseases Unit, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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14
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Rothe K, Spinner CD, Waschulzik B, Janke C, Schneider J, Schneider H, Braitsch K, Smith C, Schmid RM, Busch DH, Katchanov J. A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The "Triple F" approach supported by Procalcitonin and paired blood and urine cultures. PLoS One 2020; 15:e0240981. [PMID: 33091046 PMCID: PMC7580978 DOI: 10.1371/journal.pone.0240981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
For acute medicine physicians, distinguishing between asymptomatic bacteriuria (ABU) and clinically relevant urinary tract infections (UTI) is challenging, resulting in overtreatment of ABU and under-recognition of urinary-source bacteraemia without genitourinary symptoms (USB). We conducted a retrospective analysis of ED encounters in a university hospital between October 2013 and September 2018 who met the following inclusion criteria: Suspected UTI with simultaneous collection of paired urinary cultures and blood cultures (PUB) and determination of Procalcitonin (PCT). We sought to develop a simple algorithm based on clinical signs and PCT for the management of suspected UTI. Individual patient presentations were retrospectively evaluated by a clinical "triple F" algorithm (F1 ="fever", F2 ="failure", F3 ="focus") supported by PCT and PUB. We identified 183 ED patients meeting the inclusion criteria. We introduced the term UTI with systemic involvement (SUTI) with three degrees of diagnostic certainty: bacteremic UTI (24.0%; 44/183), probable SUTI (14.2%; 26/183) and possible SUTI (27.9%; 51/183). In bacteremic UTI, half of patients (54.5%; 24/44) presented without genitourinary symptoms. Discordant bacteraemia was diagnosed in 16 patients (24.6% of all bacteremic patients). An alternative focus was identified in 67 patients, five patients presented with S. aureus bacteremia. 62 patients were diagnosed with possible UTI (n = 20) or ABU (n = 42). Using the proposed "triple F" algorithm, dichotomised PCT of < 0.25 pg/ml had a negative predictive value of 88.7% and 96.2% for bacteraemia und accordant bacteraemia respectively. The application of the algorithm to our cohort could have resulted in 33.3% reduction of BCs. Using the diagnostic categories "possible" or "probable" SUTI as a trigger for initiation of antimicrobial treatment would have reduced or streamlined antimicrobial use in 30.6% and 58.5% of cases, respectively. In conclusion, the "3F" algorithm supported by PCT and PUB is a promising diagnostic and antimicrobial stewardship tool.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Christoph D. Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgit Waschulzik
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Janke
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Heike Schneider
- Department of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Krischan Braitsch
- Department of Internal Medicine III, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christopher Smith
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roland M. Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Juri Katchanov
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
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15
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Al Saeed ZA, Alabdrabalnabi FM, AlAnazi A, Albaker WI, Al-Sultan OA. Portal Vein Thrombosis in a Patient with Type 1 Diabetes Presenting as Acute Pyelonephritis. Eur J Case Rep Intern Med 2020; 7:001391. [PMID: 32206638 PMCID: PMC7083186 DOI: 10.12890/2020_001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/31/2019] [Indexed: 11/15/2022] Open
Abstract
Background Few cases have been reported with respect to portal vein thrombosis in non-cirrhotic patients. Asymptomatic or non-specific symptoms of portal vein thrombosis may lead to misdiagnosis or may delay the diagnosis until complications develop. We report a case of portal vein thrombosis in a patient with type 1 diabetes presenting as acute pyelonephritis. Case description An 18-year-old female with type 1 diabetes on an insulin pump presented with epigastric abdominal pain for 3 days associated with nausea and vomiting. She was a conscious, alert, young female who appeared to be in pain. Vital signs were stable with a random blood sugar (RBS) level of 179 mg/dl. Abdominal examination revealed a soft and lax abdomen with tenderness in the epigastric area and right renal angle, as well as no sign of rigidity or rebound tenderness. No signs of ascites, splenomegaly or hepatomegaly were noted. Investigations showed a WBC count of 10.2, neutrophils at 65%, urine microsopy analysis revealed WBCs between 30–50 per high power field, with culture showing >105 CFU/ml. All parameters of a thrombophilic screen were within normal values. Computed tomography (CT) revealed reduced enhancement of the right kidney, likely indicating acute pyelonephritis, and left portal vein oedema with complete occlusion. Local factors and prothrombotic disorders were ruled out. The patient was managed with ciprofloxacin, enoxaparin and warfarin. Follow-up imaging revealed complete resolution of thrombosis. Conclusions Portal vein thrombosis is an uncommon condition in the absence of liver disease. Few case reports exhibit sepsis and portal vein thrombosis. Sepsis can create a predisposed environment for hypercoagulability. To our knowledge, this is the first case report of pyelonephritis with portal vein thrombosis. LEARNING POINTS
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Affiliation(s)
| | | | - AlAnoud AlAnazi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Internal Medicine, College of Medicine, King Fahad University Hospital, Al Khobar, Saudi Arabia
| | - Waleed Ibrahim Albaker
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Internal Medicine, College of Medicine, King Fahad University Hospital, Al Khobar, Saudi Arabia.,Department of Endocrinology & Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Osma Abdullah Al-Sultan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Internal Medicine, College of Medicine, King Fahad University Hospital, Al Khobar, Saudi Arabia.,Department of Internal Medicine and Hematology, College of Medicine, King Fahad University Hospital, Al Khobar, Saudi Arabia
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16
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Uehara K, Harada Y. Misdiagnosis of Liver Abscess Resulting From Misunderstood Culture Results. Am J Med 2020; 133:e44-e45. [PMID: 31419419 DOI: 10.1016/j.amjmed.2019.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Kai Uehara
- Nagano Chuo Hospital, Nagano, Japan; Shinshu University, Matsumoto, Japan
| | - Yukinori Harada
- Nagano Chuo Hospital, Nagano, Japan; Dokkyo Medical University Hospital, Shimotsuga, Japan.
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17
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Hong JY, Suh SW, Shin J. Clinical significance of urinary obstruction in critically ill patients with urinary tract infections. Medicine (Baltimore) 2020; 99:e18519. [PMID: 31895786 PMCID: PMC6946250 DOI: 10.1097/md.0000000000018519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (P = .01 and P < .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate -3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate -2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate -6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
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Affiliation(s)
| | | | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
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18
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Jiménez-Jorge S, Palacios-Baena ZR, Rosso-Fernández CM, Girón-Ortega JA, Rodriguez-Baño J, Retamar P. Opportunities for antibiotic optimisation and outcome improvement in patients with negative blood cultures: study protocol for a cluster-randomised crossover trial, the NO-BACT study. BMJ Open 2019; 9:e030062. [PMID: 31857298 PMCID: PMC6937003 DOI: 10.1136/bmjopen-2019-030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with negative blood cultures (BCx) represent 85%-90% of all patients with BCx taken during hospital admission. This population usually includes a heterogeneous group of patients admitted with infectious diseases or febrile syndromes that require a blood culture. There is very little evidence of the clinical characteristics and antibiotic treatment given to these patients. METHODS AND ANALYSIS In a preliminary exploratory prospective cohort study of patients with BCx taken, the clinical/therapeutic characteristics and outcomes/antimicrobial stewardship opportunities of a population of patients with negative BCx will be analysed. In the second phase, using a cluster randomised crossover design, the implementation of an antimicrobial stewardship intervention targeting patients with negative BCx will be evaluated in terms of quality of antimicrobial use (duration and de-escalation), length of hospital stay and mortality. ETHICS AND DISSEMINATION This study has been and registered with clinicaltrials.gov. The findings of our study may support the implementation in clinical practice of an antimicrobial stewardship intervention to optimise the use of antibiotics in patients with negative BCx. The results of this study will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER NCT03535324.
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Affiliation(s)
- Silvia Jiménez-Jorge
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Zaira R Palacios-Baena
- Infectious Diseases and Clinical Microbiology Department, Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena, Seville, Spain
| | - Clara M Rosso-Fernández
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
- Department of Clinical Pharmacology, Virgen del Rocío University Hospital, Seville, Spain
| | - José A Girón-Ortega
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jesús Rodriguez-Baño
- Infectious Diseases and Clinical Microbiology Department, Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pilar Retamar
- Infectious Diseases and Clinical Microbiology Department, Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena, Seville, Spain
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19
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Dorsch R, Teichmann-Knorrn S, Sjetne Lund H. Urinary tract infection and subclinical bacteriuria in cats: A clinical update. J Feline Med Surg 2019; 21:1023-1038. [PMID: 31601143 PMCID: PMC6826873 DOI: 10.1177/1098612x19880435] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PRACTICAL RELEVANCE Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing. CLINICAL CHALLENGES Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended. EVIDENCE BASE This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.
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Affiliation(s)
- Roswitha Dorsch
- Clinic of Small Animal Medicine, LMU Munich, Veterinärstrasse 13, 80539 Munich, Germany
| | | | - Heidi Sjetne Lund
- Small Animal Section, Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 369 Sentrum, 0102 Oslo, Norway
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Gauthier S, Tattevin P, Soulat L, Bouget J, Abergel S, Hascoet J, Mathieu R, Beuzit L, Myhie D, Revest M, Bensalah K, Peyronnet B. Pain intensity and imaging at the initial phase of acute pyelonephritis. Med Mal Infect 2019; 50:507-514. [PMID: 31387815 DOI: 10.1016/j.medmal.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/12/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years. METHODS We performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed. Only patients who underwent an imaging study at the emergency department and with microbiologically confirmed pyelonephritis were included for analysis. The primary endpoint was the presence of urological complications on imaging findings. The secondary endpoint was treatment changes after imaging diagnosis. RESULTS Of the 193 women enrolled, 88 (45.6%) had urological complication(s) on imaging findings. The multivariate analysis revealed that history of urolithiasis (OR=2.41; P=0.01) and pain requiring morphine use (OR=5.29; P=0.009) were predictive of urological complications on imaging findings. Of the 120 women with uncomplicated pyelonephritis who underwent imaging studies, 45% had urological complication, resulting in a treatment change in 36.7% of patients. The multivariate analysis revealed that age>40 years (OR=4.58; P=0.02) and pain requiring morphine use (OR=3.78; P=0.02) were predictive of urological complication(s) on imaging findings and of treatment change based on imaging findings (OR=6.76; P=0.005 and OR=4.19; P=0.01 respectively) in this subgroup. CONCLUSIONS Pain requiring morphine use, age, and history of urolithiasis are independent predictors of urological complications on imaging findings in patients with acute pyelonephritis.
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Affiliation(s)
- S Gauthier
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France.
| | - P Tattevin
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - L Soulat
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Bouget
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - S Abergel
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Hascoet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - R Mathieu
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - L Beuzit
- Service de radiologie, université de Rennes 1, 35000 Rennes, France
| | - D Myhie
- Département de médecine générale, université de Rennes 1, 35000 Rennes, France
| | - M Revest
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - B Peyronnet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
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Tanizaki R, Ichikawa S, Takemura Y. Clinical impact of perinephric fat stranding detected on computed tomography in patients with acute pyelonephritis: a retrospective observational study. Eur J Clin Microbiol Infect Dis 2019; 38:2185-2192. [PMID: 31372906 DOI: 10.1007/s10096-019-03662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/24/2019] [Indexed: 11/26/2022]
Abstract
Perinephric fat stranding (PFS) is often detected on computed tomography (CT) in patients with acute pyelonephritis (APN). However, its clinical impact remains unclear. This study aimed to evaluate the clinical impact of PFS detected on CT in patients with APN. This retrospective observational study included patients with APN who underwent CT (median age, 79.5 years). Patients were classified into PFS (patients with PFS observed on CT) and non-PFS (patients without PFS observed on CT) groups, which were further classified into bacteraemia and non-bacteraemia groups. Clinical findings between the groups were compared. Among 194 patients who underwent CT, 111 (57.2%) patients demonstrated PFS. The rate of bacteraemia was significantly higher in the PFS group than in the non-PFS group (55.2 vs. 23.1%, p < 0.001). CT findings other than PFS were not associated with bacteraemia. The median peak body temperature was significantly higher in the PFS group than in the non-PFS group (38.8 vs. 38.5 °C, p < 0.001); however, the duration of fever and in-hospital mortality rates were not significantly different between the groups. Concordance between blood and urine culture results was observed in 75.0% of the patients; the presence of PFS was not different between patients with concordant and discordant results, regardless of the pre-treatment antibiotic used. Our findings suggest that the presence of PFS in patients with APN predicts bacteraemia; thus, clinicians should consider obtaining blood cultures if PFS is found on CT in patients with APN, even if the patients had received antibiotics prior to admission.
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Affiliation(s)
- Ryutaro Tanizaki
- Department of Community Medicine, Nabari, Mie University School of Medicine, Tsu, Mie, Japan.
- General Internal Medicine and Family Medicine, Nabari City Hospital, Nabari, Mie, Japan.
- Department of Internal Medicine, Ise Municipal General Hospital, Ise, Mie, Japan.
| | - Shuhei Ichikawa
- Department of Community Medicine, Nabari, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yousuke Takemura
- Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, Tsu, Mie, Japan
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Pierce C, Keniston A, Albert RK. Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management. South Med J 2019; 112:118-124. [DOI: 10.14423/smj.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim B, Myung R, Kim J, Lee MJ, Pai H. Descriptive Epidemiology of Acute Pyelonephritis in Korea, 2010-2014: Population-based Study. J Korean Med Sci 2018; 33:e310. [PMID: 30505253 PMCID: PMC6262185 DOI: 10.3346/jkms.2018.33.e310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/12/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. METHODS From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. RESULTS The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). CONCLUSION The epidemiology of APN in Korea has been changing with an increasing incidence rate.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science and Economics, Korea University, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Myoung-jae Lee
- Department of Economics, College of Political Science and Economics, Korea University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Karakonstantis S, Kalemaki D. A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis. Infect Dis (Lond) 2018; 50:791-803. [PMID: 30372643 DOI: 10.1080/23744235.2018.1508882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Infectious complications after transrectal prostate biopsy are rare. Nevertheless, since these are frequent procedures, the burden of infectious complications is high. Considering the increasing antimicrobial resistance, microbiological confirmation is important to guide antimicrobial therapy. METHODS We reviewed PubMed for original studies providing concurrent urine and blood culture data in symptomatic patients with transrectal biopsy-related infectious complications. We performed a proportions meta-analysis (with MedCalc) and calculated the pooled yield of urine and blood cultures and the pooled discordance rate between urine and blood cultures. RESULTS Our review identified 41 studies, involving 852 patients with infectious complications after transrectal prostate biopsy and sufficient data to calculate discordance. The pooled yield of urine cultures was 64.6% (95% CI: 56.2-72.3%, I2 83%), the pooled yield of blood cultures was 43% (95% CI: 36.5-49.7%, I2 74%) and the pooled discordance rate was 14% (95% CI: 10.6-17.8%, I2 53%). In subgroup analyses the pooled discordance was; 19.6% (95% CI: 11.8-28.9%, I2 31%) in 113 patients presenting within 2 calendar days after the biopsy and 11.2% (95% CI: 4.5-20%, I2 47%) in 143 patients presenting with fever and symptoms of lower urinary tract symptoms. The statistical and methodological heterogeneity of included studies was high. CONCLUSION Obtaining blood cultures is reasonable in all patients presenting with systemic symptoms suggestive of infection after a transrectal prostate biopsy. Blood cultures can provide additional microbiological data in about 1 of 7 patients with post-biopsy infectious complications. Prospective studies are needed to validate these results.
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Affiliation(s)
- Stamatis Karakonstantis
- a 2nd Department of Internal Medicine, General Hospital of Heraklion "Venizeleio-Pananeio" , Heraklion , Greece
| | - Dimitra Kalemaki
- b General Medicine, University Hospital of Heraklion , Heraklion , Greece
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Long B, Koyfman A. The Emergency Department Diagnosis and Management of Urinary Tract Infection. Emerg Med Clin North Am 2018; 36:685-710. [PMID: 30296999 DOI: 10.1016/j.emc.2018.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Urinary tract infection (UTI) is a common infection seen in the emergency department. The spectrum of UTI includes simple versus complicated infection and lower versus upper UTI. No one history or examination finding is definitive for diagnosis. Testing often includes urinalysis and/or urine dipstick, and several pitfalls may occur in interpretation. Urine cultures should be obtained in complicated or upper UTIs but not simple and lower tract UTIs, unless a patient is pregnant. Imaging often is not required. Most patients with simple cystitis and pyelonephritis are treated as outpatients. A variety of potentially dangerous conditions may mimic UTI and pyelonephritis.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Karakonstantis S, Kalemaki D. Blood culture useful only in selected patients with urinary tract infections – a literature review. Infect Dis (Lond) 2018; 50:584-592. [DOI: 10.1080/23744235.2018.1447682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Stamatis Karakonstantis
- 2nd Department of Internal Medicine, General Hospital of Heraklion ‘Venizeleio-Pananeio’, Heraklion, Greece
| | - Dimitra Kalemaki
- General Medicine, University Hospital of Heraklion, Heraklion, Greece
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Affiliation(s)
- James R Johnson
- From Minneapolis Veterans Affairs (VA) Health Care System and the University of Minnesota, Minneapolis (J.R.J.); and the University of Buffalo, State University of New York, and VA Western New York Health Care System, Buffalo (T.A.R.)
| | - Thomas A Russo
- From Minneapolis Veterans Affairs (VA) Health Care System and the University of Minnesota, Minneapolis (J.R.J.); and the University of Buffalo, State University of New York, and VA Western New York Health Care System, Buffalo (T.A.R.)
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Karakonstantis S, Kalemaki D. Is Taking Blood Cultures Indicated in Acute Pyelonephritis Patients Who Have Used Antibiotics before Presentation? Infect Chemother 2018; 50:48-49. [PMID: 29637753 PMCID: PMC5895831 DOI: 10.3947/ic.2018.50.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stamatis Karakonstantis
- Department of Internal Medicine, General Hospital of Heraklion Venizeleio-Pananeio, Heraklion, Greece
| | - Dimitra Kalemaki
- Department of General Medicine, University Hospital of Heraklion, Heraklion, Greece
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Imaging Technologies in the Diagnosis and Treatment of Acute Pyelonephritis. Urologia 2017; 84:179-184. [DOI: 10.5301/uj.5000234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/20/2022]
Abstract
Purpose The aim of this study was to evaluate the possibilities of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing acute pyelonephritis (AP) and renal abscess. Patients and Methods Two hundred and seven patients with AP were followed up from 2010 throughout 2015. All the patients were divided into three groups. Group 1 included 113 (54.6%) patients with acute nonobstructive pyelonephritis; group 2 included 33 (15.9%) patients with acute obstructive pyelonephritis; and group 3 included 61 (29.5%) pregnant female patients with AP. All 207 patients with AP underwent ultrasound examination of the kidneys. Computed tomography (CT) was performed in 87 patients (42.0%). MRI was performed in 14 patients (6.7%). Results We identified the ultrasound (US), magnetic resonance (MR), and CT-signs of acute renal inflammation at different stages of the process. The main us-signs were decreased mobility of the kidney, its enlargement, thickened parenchyma, hydrophilic parenchyma and an impairment of corticomedullary differentiation. The typical CT-signs of AP were enlargement of the kidney with its thickened parenchyma and an impairment of corticomedullary differentiation. The main MR-signs of AP were enlargement of the kidney (>12 cm lengthwise), thickened parenchyma (<2 cm in the median segment of the kidney) and an impairment of corticomedullary differentiation. Conclusions Assessment of the structural and functional state of renal parenchyma and the upper urinary tract using techniques such as ultrasonography, CT, MRI contributes to more efficacious treatment of patients at different stages of AP and timely drainage with properly adjusted pathogenetic therapy at the infiltrative stage is instrumental in preventing purulent destructive forms of AP.
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30
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Park SY. Overuse of Diagnostic Testing in the Management of Korean Patients with Acute Pyelonephritis. Infect Chemother 2017; 49:84-86. [PMID: 28332347 PMCID: PMC5382056 DOI: 10.3947/ic.2017.49.1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Seong Yeon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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