12 2

Usefulness of blood cultures and radiologic imaging studies in the management of patients with community- acquired acute pyelonephritis

Title
Usefulness of blood cultures and radiologic imaging studies in the management of patients with community- acquired acute pyelonephritis
Author
김지은
Keywords
Pyelonephritis; Blood culture; Diagnostic imaging; Tomography scanners X-ray computed; Ultrasonography
Issue Date
2017-03
Publisher
KOREAN SOC CHEMOTHERAPY
Citation
INFECTION AND CHEMOTHERAPY, v. 49, no. 1, page. 22-30
Abstract
Background: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for devel-oping 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.
URI
https://synapse.koreamed.org/search.php?where=aview&id=10.3947/ic.2017.49.1.22&code=0086IC&vmode=FULLhttp://repository.hanyang.ac.kr/handle/20.500.11754/113433
ISSN
2093-2340; 2092-6448
DOI
10.3947/ic.2017.49.1.22
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
Files in This Item:
Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis.pdfDownload
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE