Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission

Impacts of clinical backgrounds and intervention strategies on duration of intravenous antibiotics treatments in patients diagnosed with calculous pyelonephritis: A single-center retrospective study

OBJECTIVES

There are limited information that need to do appropriate treatment including duration of antibiotic treatments, timing of urinary drainage and pathogenesis of bacteria in calculous pyelonephritis. In the present study, we investigated real-world data on clinical features and succeeded treatment strategies in calculous pyelonephritis cases in our hospital, then, aimed to make predictive model estimating duration of intravenous antibiotics treatment.

METHODS

Participants were 163 consecutive patients diagnosed with calculous pyelonephritis who underwent antibiotics treatments between 2017 and 2023 in our in-patients' clinic. Candidates for explanatory variables that may affect duration of antibiotic treatments were age, gender, body mass index, stone location, stone size, septic status, blood culture, urine drainage, indwelling urethral catheter, diabetes mellitus and steroid intake.

RESULTS

Duration of intravenous antibiotics treatment was 6 days in median (IQR: 4-8 days). Indwelling DJ stent or percutaneous nephrostomy were undergone in 74 (45.4 %) patients. Multiple regression analysis revealed that gender, age, indwelling urethral catheter, septic status and management of urine drainage independently affected essential duration of intravenous antibiotics treatment and regression coefficient estimates of those factors respectively were 0.998, 0.890, 2.487, 1.462, 1.293 with constant of 2.464.

CONCLUSIONS

Our preliminary multiple regression models for predicting duration of intravenous antibiotics treatment may be useful to judge the timing of changing treatment strategies for patients who would not improve at around estimated intravenous antibiotics treatment periods. If vital signs were stable, it may be acceptable to judge urine drainage from above the urinary stone at around two days after intravenous antibiotic treatments.

Catheterization Does Not Improve Course of Disease in Female Patients with Acute Cystitis or Pyelonephritis: Retrospective Analysis of >300 In-Hospital Treated Patients

PURPOSE

Females with in-hospital treatment for acute cystitis (AC) or pyelonephritis may benefit from catheterization at admission.

METHODS

All female patients with AC or pyelonephritis requiring in-hospital treatment at University Hospital Frankfurt (2004-2019) were retrospectively analyzed. Logistic regression models were used to predict the catheter value.

RESULTS

Of 310 female patients, 40% harbored AC versus 60% pyelonephritis, of whom 62% and 74% received a catheter at admission: C-reactive protein (CRP) and white blood count (WBC) were significantly elevated in AC and pyelonephritis catheter versus no catheter patients (both p < 0.05). Time to CRP and WBC nadir did not differ between the AC catheter versus no catheter group (both p > 0.05). Conversely, time to CRP nadir was prolonged in pyelonephritis catheter patients. AC and pyelonephritis catheter patients exhibited a prolonged antibiotic treatment and length of stay (LOS, both p < 0.05). In multivariable analyses, CRP >5 ng/mL was a predictor for receiving a catheter in all patients. In AC, a positive urine culture and fever predicted, respectively, prolonged LOS or antibiotic treatment (all p < 0.05).

CONCLUSION

Risk factors exist with regard to receiving a catheter and prolonged antibiotic treatment or LOS in females with AC or pyelonephritis. A catheter may not accelerate recovery or WBC nadir.

[Mortality predictive factors in patients with urinary sepsis associated to upper urinary tract calculi]

PURPOSE

The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission.

DESIGN

A retrospective observational study covering a 16-year period (2006-2011) was carried out.

SETTING

The combined clinical/surgical ICU of a secondary-level University hospital.

PATIENTS

All patients admitted to the ICU due to obstructive urinary sepsis.

INTERVENTIONS

None.

MAIN VARIABLES

We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis.

RESULTS

A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality.

CONCLUSIONS

Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.