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2017 ; 49
(1
): 22-30
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of
Patients with Community-Acquired Acute Pyelonephritis
#MMPMID28271650
Kim Y
; Seo MR
; Kim SJ
; Kim J
; Wie SH
; Cho YK
; Lim SK
; Lee JS
; Kwon KT
; Lee H
; Cheong HJ
; Park DW
; Ryu SY
; Chung MH
; Pai H
Infect Chemother
2017[Mar]; 49
(1
): 22-30
PMID28271650
show ga
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.