Predictors of ultrasound abnormalities among women treated for community-onset acute pyelonephritis: a prospective study

Bruyère, F.; Conan, Yoann; Vallée, M.; Gaborit, Christophe; Crespin, Hugo; Ruimy, J.; Sotto, Albert; Grammatico‐Guillon, Leslie

doi:10.1007/s00345-022-04112-1

Cited by 4 publications

(8 citation statements)

References 13 publications

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“…The proportion of clinically significant imaging found in our study remained low (14%) considering the total population, but it was similar to the proportion found by Van Nieuwkopp et al in their derivation cohort. Clinically significant imaging ranges from 7 to 46% across studies but with considerable disparities in populations, diagnosis definitions and the proportions and types of imaging performed [ 5 , 6 , 7 , 8 , 9 , 10 , 14 , 20 , 21 , 22 ]. The varying prevalence of urolithiasis across the world (e.g., 5–9% in Europe, 7–13% in North America and 10% in Japan) could influence local practices and explain some of the different proportions of pathological imaging [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Except for a history of urolithiasis, there were no statistically significant associations with other individual Van Nieuwkoop or EAU criteria. Several factors have been associated with the imaging of urological abnormalities in other studies, including impaired renal function (elevated creatinine/blood urea nitrogen or decreased glomerular filtration rate), diabetes mellitus, inflammatory biomarkers and age [ 5 , 6 , 9 , 20 , 21 , 27 ]. Those studies also identified pain requiring opioid administration, hypotension, a history of uropathy, urinary leucocytosis, a known urinary anomaly, known kidney disease, flank pain and a Pitt score > 1.…”

Section: Discussionmentioning

confidence: 99%

“…We computed sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) and the area under the receiver operating characteristic curve (AUC) for each factor. Clinical factors were chosen based on previous studies [ 5 , 6 , 10 , 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Vanolli,

Jost,

Clerc

et al. 2024

Infectious Disease Reports

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Vanolli,

Jost,

Clerc

et al. 2024

Infectious Disease Reports

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“…However, incidence varied substantially by sex and age, likely reflecting specific risk factors for UTIs as suggested by our and other studies [ 2 , 5 , 7 , 10 ], in that elderly males, sepsis, and comorbid conditions were primarily associated with AP hospitalisation [ 2 , 11 ]. Some studies have also reported a proportion of patients hospitalised to be lower than 20% among young people, especially females, and higher in the elderly [ 2 , 10 , 22 ]. Differences in incidence rates varied compared with some other Western countries, where in-hospital AP varied widely and was usually less frequent than reported in France [ 2 , 5 , 7 , 10 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…AP may readily progress to severe urosepsis; renal dilatation requires urgent surgical management [ 2 , 7 , 9 , 24 ]. The risk factors for renal dilatation are not ascertained and accepted but represent key information for in-hospital AP that can be used to identify patients requiring urinary diversion and/or at risk of severe presentation [ 22 , 24 ]. Indeed, for economical and organisational reasons, renal imaging, which could quickly detect dilatation, is not mandatory for all patients with AP.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with urinary diversion and fatality of hospitalised acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF-2)

Grammatico-Guillon,

Laurent,

Fuhrman

et al. 2023

Epidemiol. Infect.

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Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33. 1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.

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Ultrasound for acute pyelonephritis: a systematic review and meta‐analysis

Yu,

Sri‐Ganeshan,

Smit

et al. 2024

Internal Medicine Journal

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BackgroundThere 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).AimsThe 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.MethodsA 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.ResultsThere 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.ConclusionsPatients 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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Predictors of ultrasound abnormalities among women treated for community-onset acute pyelonephritis: a prospective study

Cited by 4 publications

References 13 publications

Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Factors associated with urinary diversion and fatality of hospitalised acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF-2)

Ultrasound for acute pyelonephritis: a systematic review and meta‐analysis

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