Acute Pyelonephritis Patients Research Articles

Can excretory phase computed tomography predict bacteremia in obstructive calculous pyelonephritis?

Acute pyelonephritis (AP), a complication of urolithiasis, can be fatal if it progresses to septic shock. We aimed to evaluate the performance of excretory phase computed tomography (CT) in predicting bacteremia among AP patients with upper urinary tract calculi. We reviewed medical records of 250 patients diagnosed with AP and upper urinary tract calculi and who were admitted to our institute. We analyzed 132 patients who underwent excretory phase CT. Excretory phase CT images were obtained 7min after injection with the contrast agent. Obstruction was classified either as high or low grade. Univariate and multivariate analyses were performed to identify the risk factors of bacteremia. Of 132 patients, 73 (55.3%) had bacteremia. Escherichia coli was the most frequently identified pathogen in blood cultures. Univariate analysis demonstrated that high-grade obstruction on excretory phase CT and quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2 were correlated with bacteremia. In addition, the administration of vasopressors was significantly associated with bacteremia (31.5% vs. 6.8%; p < 0.001). Multivariate analysis identified high-grade obstruction on excretory phase CT [odds ratio (OR) 6.68; p < 0.001] and qSOFA score ≥ 2 (OR 3.59, p = 0.03) as independent risk factors for bacteremia. Excretory phase CT images can be used to predict bacteremia by evaluating the degree of ureteral obstruction. The evaluation of the passage of urine shown by excretory phase CT is critical in patients with AP associated with upper urinary tract calculi.

Antinatriuretic phenomena seen in children with acute pyelonephritis may be related to the activation of intrarenal RAAS

We investigated whether antinatriuretic phenomena [decreases in urinary sodium (uNa) and fractional excretion of sodium (FENa)] seen in children with acute pyelonephritis (APN) are associated with the renin–angiotensin–aldosterone system (RAAS).We examined 114 children experiencing their first episode of febrile urinary tract infection (fUTI) consecutively admitted to our hospital from July 2012 to June 2014. Blood tests [C-reactive protein, white blood cell count, erythrocyte sedimentation rate, and aldosterone (Aldo)] and urine tests [uNa, urine potassium (uK) and FENa] were performed upon admission. All enrolled children underwent a 99m-dimercaptosuccinic acid renal scanning (DMSA) at admission. Areas with cortical defects (AreaCD) and uptake counts (UptakeCD) on their DMSA scans were calculated. Data were compared between children with positive DMSA results (APN), lower urinary tract infection (L-UTI), and controls; and between children with high and low Aldo levels.uNa, uNa/K, and FENa negatively correlated with AreaCD%, UptakeCD, and Aldo; were significantly lower in APN patients than in LUTIs and controls regardless of Aldo level; were lower in the high Aldo group than in the low Aldo group. However, there is no difference in AreaCD% and UptakeCD between APN children with the high and low Aldo level.Decreases in uNa, uNa/K, and FENa in children with APN may result from an antinatriuretic effect of RAAS and be related to the activation of the intrarenal RAAS.

Risk Factors for Uroseptic Shock in Patients with Urolithiasis-Related Acute Pyelonephritis

Objectives: To analyze the risk factors of uroseptic shock induced by calculous acute pyelonephritis (APN). Methods: This study included 69 patients (41 were women and 28 were men) who were admitted to our hospital for APN treatment associated with urolithiasis during the period from January 2005 to December 2012. We reviewed the electronic medical records of these patients to analyze risk factors contributing to the development of uroseptic shock from APN in patients with urolithiasis. Results: Urinary drainage with ureteral stent or nephrostomy was carried out in 62 cases. Septic shock requiring vasopressor infusion against circulatory collapse was observed in 25 patients, these patients showed significantly lower serum albumin levels and higher C-reactive protein (CRP) compared to patients who did not exhibit septic shock. Multivariate analysis revealed that serum albumin level and CRP were the significant risk factors for the development of uroseptic shock from calculous APN. Conclusions: Serum albumin level was the significant risk factor for the development of uroseptic shock from calculous APN. Emergency drainage to decompress the obstructed urinary tract is mandatory as an initial urological intervention for the patients with lower serum albumin level.

Distinctive inflammatory profile between acute focal bacterial nephritis and acute pyelonephritis in children

BackgroundAcute focal bacterial nephritis (AFBN) is a severe form of upper urinary tract infection (UTI) with neurological manifestations and focal renal mass lesions on computed tomography (CT). Prolonged antibiotic therapy may improve the renal outcome, but the early differential diagnosis of AFBN from acute pyelonephritis (APN) is challenging. We searched for effective biomarkers of AFBN based on the pathophysiology of upper UTIs. MethodsOf 52 upper UTI cases treated at Yamaguchi University between 2009 and 2016, 38 pediatric patients with AFBN (n=17) or APN (n=21) who underwent ultrasonography and/or CT were enrolled. The clinical data and serum cytokine concentrations were analyzed to differentiate AFBN from APN. ResultsAFBN patients tended to be older, and have a higher body temperature, longer febrile period, more frequent neurological symptoms, higher immature neutrophil count, lower lymphocyte count, higher procalcitonin and urine β2-microglobulin levels. AFBN patients showed higher serum levels of IFN-γ, IL-6, IL-10 and soluble TNF-receptor 1 (sTNFR1) (all p<0.05). Although the cytokine levels were variably correlated among each other, multiple logistic regression analysis revealed that combination of IFN-γ and IL-6 levels were most relevant for distinguishing AFBN from APN. The discriminant power of the logistic equation was 0.86 in terms of the area under the curve by the ROC analysis. ConclusionsCirculating 4 out of 7 cytokines in AFBN patients were at higher levels compared with those in APN patients. IFN-γ and IL-6 levels might most effectively distinguish AFBN from APN.

Role of emergency ultrasound screening in the management of acute pyelonephritis in emergency department: A large observational study from a tertiary care center of South India

Background: Role of emergency ultrasound screening (EUS) in the evaluation of all patients with clinically suspected acute pyelonephritis (APN) in the emergency department (ED) remains unclear. The aim of the study was to describe the frequency of abnormal EUS findings in APN presenting to ED and ascertain the laboratory abnormalities associated with significant abnormal findings to identify the subgroup of patients who will benefit from EUS in ED. Methodology: In this retrospective study, electronic medical records were searched to identify all adult patients who underwent EUS screening from ED for initial clinical diagnosis of APN over 1 year. The EUS findings were categorized into normal, major abnormalities (hydronephrosis, renal abscess, and emphysematous pyelonephritis), and mild abnormalities (cysts, calculi, and renal edema). Results: A total of 1218 patients with initial clinically diagnosed APN underwent EUS. Nearly 49% had a normal EUS while 51% had at least one major or minor abnormality. The frequency of hydroureteronephrosis, renal calculi emphysematous changes, and renal abscess was 19.1%, 8.9%, 2.1%, and 1.9%, respectively. Only 72 (5.9%) patients required emergency percutaneous nephrostomy or drainage of an abscess. Among these patients, EUS was able to identify a major abnormality in sixty (83.3%) patients. Male gender, presence of diabetes mellitus, peripheral white blood cell (WBC) count >10,000 cells/cumm, serum creatinine >1.4 mg%, and urine WBC count >100 cells/hpf were found to independently predict the presence of an abnormality on an EUS. Conclusion: A large proportion of APN patients have only normal or minor abnormalities and do not need additional screening and intervention.

Plasmatic presepsin (sCD14-ST) concentrations in acute pyelonephritis in adult patients

IntroductionPresepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity. MethodsWe compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients. ResultsIn 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p<0.001). ROC curve indicated an AUC at 0.90 [for presepsin (vs. 0.99 and 0.98 for CRP and PCT, respectively; p<0.05) and an optimal threshold at 340ng/L (74% sensitivity, 94% specificity). Presepsin concentrations increased in acute pyelonephritis patients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, p<0.001). Performance of presepsin to predict bacteraemia [AUC=0.63, 95%CI: 0.55–0.72] was similar to CRP (AUC=0.64, p=0.87) and less accurate than PCT (AUC=0.78, p<0.001). AUC for presepsin to detect the need for admission was 0.67, and comparable to CRP (p=0.26) and PCT (p=0.18). ConclusionPresepsin is a valuable biomarker to detect patients with acute pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT.

Retrospective Comparison of Clinical Characteristics and In-Hospital Outcomes among Diabetic and Non-Diabetic Adults with Acute Pyelonephritis.

Acute Pyelonephritis (APN) is a common infection in community. Diabetes Mellitus (DM) may have different effect on clinical characteristics and outcomes of APN compared to non-diabetic individuals. To compare clinical characteristics and assess outcomes of APN patients with and without DM. A retrospective analysis of 122 patients with DM (n=61) and without DM (n=61) was conducted at a single, private, urban set-up from Gujarat, India. Clinical symptoms, laboratory investigations, antibiotics treatment and outcomes in terms of mortality and prolonged hospitalization (10 days and above) were compared in two groups. Mean age was significantly higher in diabetics than non-diabetics (55.2±12.5 vs 41.5±17.3, p<0.0001) and females were proportionally higher in both groups (65.6% Vs 62.3%, p=0.706). Fever was most frequent symptom (83.6% Vs 90.2%, p=0.283) followed by nausea/vomiting (50.8% Vs 63.9%, p=0.143), dysuria (66.7% Vs 74.4%, p=0.433) and flank pain (8.2 Vs 13.1, p=0.379). Backache/back pain (47.5% Vs 29.5%, p=0.041) and Chronic Kidney Disease (CKD) (63.9% Vs 45.9%, p=0.045) were significantly higher in diabetics than non-diabetics. Mean hospital stay did not vary significantly in two groups (7.0±3.2 Vs 6.50±2.9, p=0.346) but proportion of patients with longer hospital stay was higher in DM (16.4% Vs 8.2%). Elevated white cell count, erythrocyte sedimentation rate, C-reactive protein, serum creatinine and presence of red cell in urine (> 5/ high power field [hpf]) did not vary significantly in two groups. Cephalosporin-beta-lactamase inhibitor (Cefaperazone-Sulbactam/Cefepime-Tazobactam) was the most prescribed antibiotic in both the groups. No deaths were observed in any group during this evaluation period. Only raised ESR (>30 mm/hr) {Odds Ratio (OR): 1.58, 95% Confidence Interval (CI) 1.36-1.82, p=0.004} and presence of CKD (OR: 1.71, 95% CI 1.30-2.25, p=0.008) were found to be the significant predictors of prolonged hospitalization in overall population. APN in diabetic and non-diabetic patients has similar clinical characteristics. Impact of diabetes on clinical outcomes of mortality and prolonged hospitalization warrants further investigation in a large, randomized, prospective trial.

Mean platelet volume in young children with urinary tract infection

Mean platelet volume (MPV) has not yet been well-established in urinary tract infection (UTI). The purpose of this study was to evaluate the role of MPV as an acute phase reactant in children with UTI. Data from 118 young children (<2 years) with UTI between 2012 and 2013 were grouped as acute pyelonephritis (APN) and lower UTI according to the dimercaptosuccinic acid (DMSA) scan abnormalities. MPV, platelet distribution width (PDW) platelet count, and other infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) were measured. WBC (P = 0.001), ESR (P = 0.005), CRP (P < 0.001) and MPV levels (P = 0.011) were significantly higher in the APN group than those in the lower UTI group. MPV positively correlated with PDW, CRP and negatively with platelet count. Multiple logistic regression analyses showed that CRP and MPV were independent predictive factors for APN patients. However, the area under the Receiver Operating Characteristic (ROC) curve analysis for MPV was lower than CRP. Our results suggest that MPV can be an inflammatory marker in UTI, but the predictive value of MPV was not superior to CRP in the diagnosis of APN.

Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis.

The aims were to assess (1) the diagnostic value of serum procalcitonin (PCT) for acute pyelonephritis (APN) in infants and children with urinary tract infections (UTIs) and (2) to compare the performance of two commonly used cutoff values. A meta-analysis of serum PCT in the diagnosis of APN among pediatrics with lower UTIs was conducted. The process of search strategy, publications selection and data analysis was in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. Eighteen high-quality studies with a total of 831 APN patients and 651 individuals with lower UTIs were analyzed. The overall performance of serum PCT ≥ 0.5 ng/mL was as follows: pooled sensitivity of 0.86 (95 % CI 0.73-0.93), pooled specificity of 0.76 (95 % CI 0.66-0.83), DOR of 18.90 (95 % CI 6.78-52.71) and AUROC of 0.86 (95 % CI 0.83-0.89), with significant heterogeneity. However, use of 1.0 ng/mL as a cutoff value produced an improved specificity of 0.91 (95 % CI 0.86-0.94), a DOR of 55.06 (95 % CI 22.57-115.48) and an AUROC of 0.94 (95 % CI 0.92-0.96), without obvious heterogeneity. In pediatrics with UTIs, the cutoff value of serum PCT, 1.0 ng/mL, has a preferable diagnostic performance compared with 0.5 ng/mL for APN. Additional prospective studies that propose an appropriate cutoff value and validate the performance of PCT for young with APN are needed in the future.

Impact of extended-spectrum β-lactamase production on treatment outcomes of acute pyelonephritis caused by escherichia coli in patients without health care-associated risk factors.

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused by E. coli at a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3; P = 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38; P = 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65; P = 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused by E. coli showed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30; P = 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12; P = 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associated E. coli APN.

Effects of Diabetes Mellitus and HbA1c on Treatment Prognosis in Uncomplicated Acute Pyelonephritis

Purpose: We investigated potential difference in the clinical features of hospitalized female acute pyelonephritis (APN) patients with and without diabetes mellitus (DM). The additional purpose of the study was to determine whether HbA1c has a role in predicting clinical outcome in terms of morbidity compared with those considered to have normal glycemic control in female APN patients with DM. Materials and Methods: Among the female patients who received inpatients care due to APN from January 2011 to December 2013, 282 patients (86 with DM and 196 without DM) were selected and their medical records were analyzed. Laboratory results (white blood cell, blood urea nitrogen, serum creatinine, fasting plasma glucose, HbA1c) were dichotomized. Primary outcomes for comparison between the groups of patients with or without DM were early clinical response rate and length of in-hospital stay. Subgroup analysis was also performed in DM patients according to HbA1c status (<6.5%, ≥6.5%). Results: In multivariate logistic regression analysis, DM was not found to show independent association with poor early clinical response or longer hospital stay. HbA1c was the common risk factor of poor early clinical response (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.61-14.8) and longer hospital stay (OR 4.20 95% CI 1.52-11.60) in APN patients with DM. Conclusions: Strict glucose control may be more important prognostic factor than presence or absence of DM in APN patients. As a marker of prolonged hospitalization and poor early clinical response, HbA1c can complement the present clinical and laboratory parameters used as guide in the proper treatment of DM patients with APN.

Factors influencing length of stay and suitability for early community discharge in the management of acute pyelonephritis

Objectives:We assessed factors influencing length of stay and suitability for early discharge to community care in acute pyelonephritis (APN).Methods:APN patients admitted in 2011–2012 to a tertiary hospital were included in a retrospective study. Data collected included patient demographics, Charlson Comorbidity Index (CCI), admitting speciality, imaging, length of stay and any intervention.Results:A total of 266 patients were analysed with 83.1% managed by urologists and the rest by other specialties. Urology patients had a shorter mean stay of 4.7 days compared to 8.8 days for non-urology patients ( p &lt; 0.001). The mean time to imaging was 0.5 days and 1.4 days for urology and other specialties, respectively ( p &lt; 0.001). Twenty per cent of patients had urinary tract abnormalities on imaging but only 2.0% required intervention; 9.4% (25/266) had repeated imaging following an initial scan but none resulted in an intervention. A high CCI was a predictor of longer stays regardless of admitting speciality ( p &lt; 0.001). Admission to non-urological specialities remained a significant predictor both of delayed imaging ( p = 0.001) and longer stays ( p &lt; 0.001) even after correction for CCI.Conclusion:Time to imaging, comorbidity and admitting speciality are key factors influencing APN management. Rapid urological review and imaging could identify patients suitable for safe early discharge to community management.

STATE OF URINARY TRACTS’IMMUNITYINPATIENTS WITH ACUTE PYELONEPHRITIS AND CYSTITIS

Materials and methods. 64 patients with acute pyelonephritis (AP) and 15 healthy women were examined. in urine were determined indices which characterized a state of urinary tracts’ immunity. The analysis of immunological data of urine was carry out in patients with AP (first detected) and by exacerbation chronic pyelonephritis with concomitant cystitis (acute or chronic) or without him.&#x0D; Results. in urine of AP patients were marked useful increase of levels of many immunological indices – complement’s C3–component, lactoferrin, lisozym, myeloperoxidasa, immunoglobulins A, М, G, secretory igA (sigA), secretory component (SC) and cytokine’s disbalans TNF– a and iL–10 with predomination of proinflammatory cytokines.&#x0D; Conclusions. in urine of patients with AP and cystitis observed the greatest elevation of above–mentioned indices levels except igA, sigA and SC level. The reliable differences between the groups of patients with AP with concomitant acute or chronic cystitis don’t showed save the igM level which reliable rised in patients with acute cystitis.&#x0D;

Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis.

PurposeComputed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN.Materials and MethodsFrom July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria.ResultsThe most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively).ConclusionsThe uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

Use of Gentamicin for Women with Community-Acquired Uncomplicated Acute Pyelonephritis Caused by Gentamicin-Susceptible or -ResistantEscherichia coli:10-Year Experience

The objectives of this study were to evaluate the clinical effectiveness of gentamicin as an initial empirical antimicrobial agent and to determine the effects of gentamicin resistance on clinical outcomes in women with uncomplicated acute pyelonephritis (APN). We analyzed data of 2,033 women with a diagnosis of APN admitted to Catholic University St. Vincent's Hospital. Of those, we enrolled 274 cases of community-acquired uncomplicated APN due to Escherichia coli who received gentamicin as initial antibiotics. Of these 274 patients, 47 patients had gentamicin-resistant (GM-R) E. coli APN, and 227 patients had gentamicin-susceptible (GM-S) E. coli APN. The early clinical response rates were 55.3% (26/47) versus 81.5% (185/227) at 72 hours; 61.7% (29/47) versus 96.9% (220/227) at 96 hours in the GM-R and GM-S groups, which was significantly higher in the GM-S group (p<0.001). Overall clinical cure rates were 100% (47/47) and 99.6% (226/227) in the GM-R and GM-S groups, respectively. APN patients in the GM-R group had longer hospitalization (9.72 ± 3.46 and 7.89 ± 2.27 days; p<0.001) than those in the GM-S group. Resistance of E. coli to gentamicin, bacteremia, and C-reactive protein level showed independent effects on early clinical failure. Aminoglycoside such as gentamicin can be an alternative antibiotic option for initial empirical therapy of community-acquired uncomplicated APN as the fluoroquinolone-sparing or broad-spectrum cephalosporin-sparing agents in an era of increasing antimicrobial resistance, especially in areas where medical resources are limited or antibiotic resistance rate of the uropathogens is high.

Genetic Polymorphisms in Toll-Like Receptors among Pediatric Patients with Renal Parenchymal Infections of Different Clinical Severities

BackgroundAlthough several studies have suggested single gene defects or variations in the genes associated with host immune response could confer differences in susceptibility to urinary pathogen invasion, no studies have examined the genetic polymorphisms in various toll-like receptors (TLRs) that activate innate immune responses in pediatric renal parenchymal infections of different clinical severities, namely acute pyelonephritis and the clinically more severe disease, acute lobar nephronia.MethodologyPatients who fulfilled the diagnostic criteria for acute pyelonephritis (APN) and acute lobar nephronia (ALN) without underlying diseases or structural anomalies, except for vesicoureteral reflux (VUR), were enrolled. Genotyping of the single nucleotide polymorphisms (SNPs) in the genes encoding TLR-1, TLR-2, TLR-4, TLR-5, and TLR-6 was performed by matrix-assisted laser desorption/ionization time-of-flight-based mini-sequencing analysis.Principal FindingsA total of 16 SNPs were selected for genotyping. Analysis of 96 normal and 48 patients’ samples revealed that only four SNPs had heterozygosity rates >0.01. These SNPs were selected for further investigation. Hardy-Weinberg equilibrium was satisfied for the observed genotype frequencies. Statistically significant differences in the genotype frequency of TLR-2 (rs3804100, T1350C) between controls and ALN or (APN+ALN) combined group were identified using the recessive model with the correction for multiple-SNP testing. Further genotype pattern frequency analysis in TLR-2 SNPs (rs3804099 and rs3804100) showed significantly reduced occurrence of the rare allele homozygote (CC+CC) in the no-VUR subgroup of APN and ALN cases.ConclusionsAs the inflammatory responses in ALN patients are more severe than those in APN patients (higher CRP levels, longer duration of fever after antibiotic treatment), these findings suggest that the genetic variant in TLR-2 (rs3804100, T1350C) may protect the host from severe urinary tract infections as ALN.

ON TIMELY DETECTION OF ACUTE PYELONEPHRITIS PATIENTS WITH DIABETES

The paper analyzes data for early detection of acute pyelonephritis in patients with diabetes. The study was conducted from 2006 to 2011 GG The study group included 149 patients with UCP. During the analyzed period (2007-2011 years) was an increase in frequency of the isolation of microbial inoculation microflora from 47.8 to 53.4%. Predominant pathogen infections of the upper urinary tract in patients with diabetes was E.coli - 80-85%, enterococci isolated in 5-6,6%, Pseudomonas, (primarily P. Aeroginosa) at 1.7-3% Streptococcus - 0,7-2,2%.

901 CLINICAL COURSES OF ADULTS WITH ACUTE PYELONEPHRITIS CORRELATED WITH GRADE USING COMPUTED TOMOGRAPHY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2012901 CLINICAL COURSES OF ADULTS WITH ACUTE PYELONEPHRITIS CORRELATED WITH GRADE USING COMPUTED TOMOGRAPHY Hyeong Gon Kim, Kyung Kyu Jun, Gwoan Youb Choo, Hyoung Keun Park, Sung Hyun Paick, and Yong Soo Lho Hyeong Gon KimHyeong Gon Kim Seoul, Korea, Republic of More articles by this author , Kyung Kyu JunKyung Kyu Jun Seoul, Korea, Republic of More articles by this author , Gwoan Youb ChooGwoan Youb Choo Seoul, Korea, Republic of More articles by this author , Hyoung Keun ParkHyoung Keun Park Seoul, Korea, Republic of More articles by this author , Sung Hyun PaickSung Hyun Paick Seoul, Korea, Republic of More articles by this author , and Yong Soo LhoYong Soo Lho Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.997AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to develop acute pyelonephritis (APN) grading system using computed tomography (CT) and find relationship with clinical courses of APN. METHODS We performed the prospective study between 2007 and 2011. All APN patients were underwent CT study and were divided into 4 grade groups according to the renal parenchyma involvement of infection on CT finding; grade 1: no lesion in CT, grade 2: <25% of parenchyma involvement, grade 3: 25% - 50% involvement and grade 4 group: >50% involvement. The severity index of APN was evaluated with the peak body temperature, the level of CRP and the level of leukocytosis. The recovery index was evaluated with the hospital days, duration of fever and duration of intravenous antibiotics treatment. The severity index and recovery index were compared among the patients groups. RESULTS A total of 234 patients were included in this study. Among these patients, urinary stone was found in 21 patients and renal abscess was found in 10 patients. Excluding these patients, analysis was performed in 204 patients. Mean peak temperature was 38.9°C. The level of c-reactive protein (CRP) elevation was 11.4 mg/dl and the level of white blood cell elevation was 12097.8 /ul. Mean hospital day was 6.5 days and the duration of fever was 1.6 days. As the increase of CT grading, the severity index including the peak body temperature, the level of CRP and the level of leukocytosis was significantly increased. In addition, the recovery index was increased according to the CT grading group. Hospital day was increased from 5.7 days in the group 1 to 7.6 days in the group 4 (p < 0.001) and fever duration was increased from 0.9 days in the group 1 to 1.9 days in the group 4 ( p = 0.005). CONCLUSIONS CT grading according to renal involvement was well correlated with the severity and recovery in APN patients. This CT grading might provides a useful tool to predict the clinical course of APN. Table 1. Comparisons according to APN grades Overall Group 1 Group 2 Group 3 Group 4 P value Severity index Peak body temperature (°) 38.9 38.2 38.6 39.1 38.9 0.001 Peak CRP (mg/dl) 11.4 3.6 6.8 12.4 21.9 0.000 Peak leukocytosis (/ul) 12098.1 9935.4 10210.6 12411.0 16005.4 0.000 Recovery index Hospital stay (days) 6.5 5.7 6.1 6.5 7.6 0.000 Fever duration (days) 1.5 0.9 1.4 1.7 1.9 0.005 Antibiotics duration (days) 6.2 5.5 5.9 6.1 7.4 0.000 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e367 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyeong Gon Kim Seoul, Korea, Republic of More articles by this author Kyung Kyu Jun Seoul, Korea, Republic of More articles by this author Gwoan Youb Choo Seoul, Korea, Republic of More articles by this author Hyoung Keun Park Seoul, Korea, Republic of More articles by this author Sung Hyun Paick Seoul, Korea, Republic of More articles by this author Yong Soo Lho Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary Macrophage Migration Inhibitory Factor Serves as a Potential Biomarker for Acute Kidney Injury in Patients with Acute Pyelonephritis

Conventional markers of kidney function that are familiar to clinicians, including the serum creatinine and blood urea nitrogen levels, are unable to reveal genuine injury to the kidney, and their use may delay treatment. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine, and the predictive role and pathogenic mechanism of MIF deregulation during kidney infections involving acute kidney injury (AKI) are not currently known. In this study, we showed that elevated urinary MIF levels accompanied the development of AKI during kidney infection in patients with acute pyelonephritis (APN). In addition to the MIF level, the urinary levels of interleukin (IL)-1β and kidney injury molecule (KIM)-1 were also upregulated and were positively correlated with the levels of urinary MIF. An elevated urinary MIF level, along with elevated IL-1β and KIM-1 levels, is speculated to be a potential biomarker for the presence of AKI in APN patients.

Change of Antimicrobial Susceptibility amongEscherichia coliStrains Isolated from Female Patients with Community-Onset Acute Pyelonephritis

PurposeThere is a concern on which antimicrobials are appropriate as empirical agents for community-onset acute pyelonephritis (APN) in regions where the fluoroquinolone resistance rate is high, such as in Korea.Materials and MethodsThree hundred and two strains of E. coli in 2001-2002 and 349 strains in 2008-2009 were isolated from the urine cultures of female adult APN patients, and the antimicrobial susceptibility was compared according to each study period. All the patients were classified as uncomplicated or complicated APN, and a subgroup analysis was done thereafter.ResultsThe E. coli strains isolated in 2008-2009 showed improved susceptibility to trimethoprim-sulfamethoxazole compared to those isolated in 2001-2002. However, the third generation cephalosporin and gentamicin susceptibility was worsened. Of the 232 isolates from the uncomplicated APN patients, there was no difference between the two different time periods. On the other hand, of the 419 isolates from the complicated APN patients, the susceptibility to third generation cephalosporin, gentamicin and ciprofloxacin was significantly worsened.ConclusionThe antimicrobial susceptibility of E. coli changed over the study period, however, this change occurred mainly in the complicated APN patients. In Korea, ciprofloxacin is still useful as an empirical agent for uncomplicated APN patients, but this is not the case for patients with complicated APN because of high resistance rate to ciprofloxacin in these patients. For the complicated APN patients, the rate of resistance to ciprofloxacin is already more than 30%.