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Usefulness of blood cultures and Radiologic imaging studies in the mangement of patients with commuinity acquired acute pyelonephritis

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Author(s)
Yeonjae KimMi-Ran SeoSeong-Jong KimJieun KimSeong-Heon WieYong Kyun ChoSeung-Kwan LimJin Seo LeeKi Tae KwonHyuck LeeHee Jin CheongDae Won ParkSeong Yeol RyuMoon-Hyun ChungHyunjoo Pai
Keimyung Author(s)
Ryu, Seong Yeol
Department
Dept. of Internal Medicine (내과학)
Journal Title
Infection and Chemotherapy
Issued Date
2017
Volume
49
Issue
1
Keyword
PyelonephritisBlood cultureDiagnostic imagingTomography scanners X-ray computedUltrasonography
Abstract
Background: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing
therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients.
Materials and Methods: We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March
2010 to February 2011.
Results: Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827
CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures
were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures
were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0%
vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were
significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to
radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal
ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis,
hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with
Pitt score ≥1, flank pain or azotemia were significantly more likely to have such structural abnormalities.
Conclusion: Blood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality.
Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.
Keimyung Author(s)(Kor)
류성열
Publisher
School of Medicine
Citation
Yeonjae Kim et al. (2017). Usefulness of blood cultures and Radiologic imaging studies in the mangement of patients with commuinity acquired acute pyelonephritis. Infection and Chemotherapy, 49(1), 22–30. doi: 10.3947/ic.2017.49.1.22
Type
Article
ISSN
2093-2340
DOI
10.3947/ic.2017.49.1.22
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32589
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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