Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis
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Background: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developingtherapeutic 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 March2010 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 827CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultureswere performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultureswere 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 weresignificantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard toradiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominalultrasonography. 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 withPitt 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.
Abstract
Background: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developingtherapeutic 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 March2010 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 827CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultureswere performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultureswere 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 weresignificantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard toradiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominalultrasonography. 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 withPitt 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.
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