Acute Pyelonephritis in the Elderly

Gleckman, Richard A.; Blagg, Noel; Hibert, Debra; Hall, Arthur; Crowley, Monique; Pritchard, Anne; Warren, William

doi:10.1097/00007611-198205000-00011

Cited by 47 publications

(12 citation statements)

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“…In women, studies have found that the 16% incidence of positive blood cultures in young patients rises to 52% in those patients older than 65 years.18 Elderly men had the highest risk at 88%. 18 In sample groups that were reasonably well matched for sex and age, our study noted a similar incidence of 27% compared with the 20% cited by Grover et al" Both studies concurred in finding bacteremia suggestive of nonacute structural abnormalities or stones over patients with nor¬ mal findings. We were surprised by and unable to explain, except on the basis of a small sample, why there were no patients with bacteremia among the five class I cases.…”

Section: Analysis Of Modelsupporting

confidence: 83%

The Intravenous Pyelogram in Acute Pyelonephritis

Kanel

Kroboth²,

Schwentker³

et al. 1988

Arch Intern Med

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Section: Analysis Of Modelsupporting

confidence: 83%

The Intravenous Pyelogram in Acute Pyelonephritis

Kanel

Kroboth²,

Schwentker³

et al. 1988

Arch Intern Med

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“…More refinement is possible if the urinary isolates can be categorized according to the severity of the clinical syndrome, i.e., acute pyelonephritis (most severe; associated with fever, chills, and flank pain from renal inflammation), cystitis (moderately severe; associated with burning and pain on voiding plus, possibly, suprapubic pain or tenderness from bladder inflammation), or ABU (least severe; characterized by the total absence of symptoms) (149,231). Comparisons of prevalence of the property of interest can then be made between the various UTI syndromes.…”

Section: Investigation Of Vfsmentioning

confidence: 99%

Virulence factors in Escherichia coli urinary tract infection

1991

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Uropathogenic strains of Escherichia coli are characterized by the expression of distinctive bacterial properties, products, or structures referred to as virulence factors because they help the organism overcome host defenses and colonize or invade the urinary tract. Virulence factors of recognized importance in the pathogenesis of urinary tract infection (UTI) include adhesins (P fimbriae, certain other mannose-resistant adhesins, and type 1 fimbriae), the aerobactin system, hemolysin, K capsule, and resistance to serum killing. This review summarizes the virtual explosion of information regarding the epidemiology, biochemistry, mechanisms of action, and genetic basis of these urovirulence factors that has occurred in the past decade and identifies areas in need of further study. Virulence factor expression is more common among certain genetically related groups of E. coli which constitute virulent clones within the larger E. coli population. In general, the more virulence factors a strain expresses, the more severe an infection it is able to cause. Certain virulence factors specifically favor the development of pyelonephritis, others favor cystitis, and others favor asymptomatic bacteriuria. The currently defined virulence factors clearly contribute to the virulence of wild-type strains but are usually insufficient in themselves to transform an avirulent organism into a pathogen, demonstrating that other as-yet-undefined virulence properties await discovery. Virulence factor testing is a useful epidemiological and research tool but as yet has no defined clinical role. Immunological and biochemical anti-virulence factor interventions are effective in animal models of UTI and hold promise for the prevention of UTI in humans.

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“…2006). In the West, studies from autopsies and chart reviews have revealed that acute pyelonephritis increases the risk of bacteremia and septic shock in geriatric inpatients, and is also a commonly-ignored cause of death in these patients (Gleckman et al 1982;Gee 1993). In Taiwan, there is still little literature about acute pyelonephritis in geriatric populations.…”

Section: Statistical Analysesmentioning

confidence: 99%

The Characteristics of Acute Pyelonephritis in Geriatric Patients: Experiences in Rural Northeastern Taiwan

Kang¹,

Tsao²,

Liu³

et al. 2008

Tohoku J. Exp. Med.

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Acute pyelonephritis causes hospitalization and is a commonly-ignored cause of death in geriatric patients. It has been well studied in young-adult populations but rarely in geriatric populations. The aim of our study was to analyze the characteristics of acute pyelonephritis in geriatric patients. The electronic admission records of a community hospital in northeastern Taiwan were retrospectively screened from July 1, 2003 to June 30, 2006. The basic characteristics, laboratory fi ndings and infectious microorganisms of all subjects were evaluated. Sixty-fi ve subjects (mean age 71.6 ± 4.9 years; range 65-84 years) and 73 admission records contributed by them were enrolled. These 65 subjects, including one who died in hospital, were predominantly female (52 subjects; 80%). Twenty-two subjects (33.8%) had co-existing diabetes mellitus, 9 subjects (13.8%) had co-existing tumors, and 19 subjects (29.2%) had a history of intra-abdominal surgery. The admission records revealed right kidney involvement (52.1%), co-existing urolithiasis (50.7%) and admission to wards of internal medicine (57.5%). Urological procedures were performed on 20 (27.4%) of all 73 admission records. Escherichia coli was the most common infecting microorganism (19.2% of all records; 42.4% of records with positive microorganism culture). Hemoglobin < 10 g/dl was a signifi cant predictive factor for both hospital stay > 7 days and serum creatinine > 2.0 mg/dl ( p = 0.003 and 0.002, respectively). Positive microorganism culture was also a signifi cant predictive factor for hospital stays > 7 days ( p < 0.001). In our geriatric patients with acute pyelonephritis, low hemoglobin levels implied co-existing renal insuffi ciency and prolonged hospitalization. Positive microorganism culture also implied prolonged hospitalization.

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Acute Pyelonephritis in the Elderly

Cited by 47 publications

References 0 publications

The Intravenous Pyelogram in Acute Pyelonephritis

The Intravenous Pyelogram in Acute Pyelonephritis

Virulence factors in Escherichia coli urinary tract infection

The Characteristics of Acute Pyelonephritis in Geriatric Patients: Experiences in Rural Northeastern Taiwan

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