Acute Pyelonephritis in Adults

Abstract

Background: To formulate a classification tool for early recognition of patients admitted with acute pyelonephritis (AP) who are at high risk for failure of treatment or for death.Methods: A retrospective chart review of 225 patients (102 men) admitted with AP. We considered 13 potential risk factors in a multivariate analysis.Results: Recent hospitalization, previous use of antibiotics, and immunosuppression were found to be independent correlates of the prevalence of resistant pathogens in both sexes. Additional predictors included nephrolithiasis in women and a history of recurrent AP in men. Prolonged hospitalization should be expected for a man with diabetes and long-term catheterization who is older than 65 years or for a woman of any age with the same characteristics, when the initial treatment was changed according to the results of urine culture. For mortality prediction, we derived an integer-based scoring system with 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for previous antibiotic treatment for men and 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for immunosuppression for women. Among patients with at least 11 points, the risk for in-hospital death was 100% for men and 91% for women. Conclusions:Simple variables available at presentation can be used for risk stratification of patients with AP. The additional identification of certain risk factors by means of a carefully obtained history could contribute to early recognition of patients infected by resistant bacteria and optimize the selection of antimicrobial agents.

Propensity-Matched Analysis To Compare the Therapeutic Efficacies of Cefuroxime versus Cefotaxime as Initial Antimicrobial Therapy for Community-Onset Complicated Nonobstructive Acute Pyelonephritis Due to Enterobacteriaceae Infection in Women

“…Additionally, clinicians should consider complicating factors when making decisions for the treatment of complicated APN, especially in patients who have risk factors for poor clinical response (18)(19)(20). In this study, there were no significant differences between the early clinical failure and success groups in the proportions of uropathogens that were resistant to antimicrobial agents, such as ampicillin, cefazolin, cefoxitin, cefotaxime, cefepime, fluoroquinolone, and uropathogens that produce ESBL.…”

Risk factors for treatment failure in renal suppurative infections

“…It has been shown, for example, that shock, bedridden status, age over 65 years, and previous antibiotic treatment were factors which put subjects with acute pyelonephritis in the group of high risk for fatal outcome [11]. However, the prediction was not based on single-factor analysis; instead they were combined in a categorical scoring scale and, therefore, little is known about the influence of particular risks when they are present separately from others.…”

“…The soundest data come from a largescale, retrospective analysis in which six underlying conditions (congestive heart failure, advanced diabetes, angioplasty, quadriplegia, hypoalbuminemia, and hydronephrosis) and two surgical parameters (the length of surgery and transfusions) were found to be predictors of 1-month postoperative morbidity after common urological major surgery [12]. Conflicting results were obtained for elderly [9,11], and acute or chronic disturbances in glucose metabolism, favoring advanced stages of diabetes mellitus as an important predictor of poor outcome [9,10].…”

“…They usually include too many variables in the prediction model, and are ''too enthusiastic'' in their conclusions. In one such study, supposed risks were combined in a categorical scoring scale, then analyzed, but finally present separately from each other [11]. Furthermore, in the absence of more reliable data, some studies used a remarkable clinical feature as a presumed proxy for treatment failure.…”

Association between Mannose-Binding Lectin Deficiency and Septic Shock following Acute Pyelonephritis Due toEscherichia coli

“…Despite the fact that most cases of AP have a good prognosis, they often require prolonged therapy and, when accompanied by bacteremia, AP has a mortality rate of 10 to 20% (31). Several host conditions, such as immunosuppression (44), age (27), diabetes (29,32), pregnancy (14), and bedridden status (6), have been associated with more serious forms of AP.…”