Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to<i>Escherichia coli</i>

Oh, Seon Jung; Je, Bo-Kyung; Lee, Seung Hwa; Choi, Won Suk; Hong, Doran; Kim, Sung-Bum

doi:10.4329/wjr.v8.i4.403

Cited by 8 publications

(4 citation statements)

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“…In the context of APN, CT has been considered the method of choice for assessment of the extent of inflammatory involvement of renal parenchyma, detection of bilateral infections and complications, and for providing an alternative diagnosis, if applicable (1,7,8). A multiphase CT protocol (pre- and post-contrast) has been the widespread current practice (1,7,9,10,16).…”

Section: Discussionmentioning

confidence: 99%

“…elderly, immunocompromised) with atypical symptoms or no response to antibiotic therapy within 72 h (8,9). The most widely accepted CT protocol for diagnosis of APN includes at least a pre- and post-contrast scan (9), with the use of triphasic scans (pre-contrast, nephrographic, and excretory phases) still being often reported in the literature (1,10,11).…”

Section: Introductionmentioning

confidence: 99%

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Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

et al. 2016

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Background The most widely accepted computed tomography (CT) protocol for diagnosis of acute pyelonephritis (APN) includes at least a pre- and post-contrast scan, which may expose patients to higher doses of ionizing radiation. Purpose To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. Material and Methods A retrospective study of 100 consecutive patients (88 women; age range, 19-70 years) with clinical and laboratory suspicion of APN and who underwent triphasic abdominal CT scans (non-contrast, nephrographic, and excretory phases) was performed. Two readers first evaluated independently only the nephrographic phase of scans, and, in a second session, the entire study. The diagnostic reference standard was settled by a third experienced radiologist who reviewed all triphasic scans and clinical data. Results The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. Conclusion CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase, with consequent dose reduction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

et al. 2016

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“…BSIs and non-BSIs. In addition, studies have been conducted comparing bacteremic and non-bacteremic pneumonia caused by S. pneumoniae and Acinetobacter baumannii ( 20 , 21 ), as well as bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli ( 22 ). Given the rapid progression and high motility of CRKP, it is still crucial to identify the risk factors for CRKP BSIs in patients in infected patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of bloodstream and non-bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae in the intensive care unit: a 9-year respective study

Sun,

Zou,

Zhou

et al. 2023

Front. Med.

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BackgroundBloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have received much attention. However, few studies have identified risk factors for CRKP BSIs in comparison to CRKP non-bloodstream infections (non-BSIs). This study aimed to compare the epidemiology, risk factors, and outcomes of CRKP BSIs and CRKP non-BSIs.MethodsWe conducted a retrospective study of patients infected with CRKP in the ICU from January 2012 to December 2020. Clinical characteristics and outcomes were compared between CRKP BSIs and CRKP non-BSIs. Predictors associated with 28-day all-cause mortality in CRKP-infected patients were also evaluated.Results326 patients infected with CRKP were enrolled, including 96 patients with CRKP BSIs and 230 with CRKP non-BSIs. The rates of CRKP BSIs in CRKP infections were generally raised from 2012 (12.50%) to 2020 (45.76%). Multivariate logistic analysis indicated that the use of carbapenems within the prior 90 days was an independent risk factor for CRKP BSIs (p = 0.019). Compared to CRKP non-BSIs, CRKP isolates in the CRKP BSI group were found to be non-susceptible to more tested carbapenems (p = 0.001). Moreover, the CRKP BSI group exhibited a higher mortality rate (p = 0.036). The non-susceptibility of CRKP isolates to more tested carbapenems (p = 0.025), a high SOFA score (p = 0.000), and the use of antifungal drugs within the prior 90 days (p = 0.018) were significant factors for 28-day all-cause mortality in CRKP-infected patients.ConclusionThe proportion of CRKP BSI increased progressively in CRKP-infected patients over 9 years. The use of carbapenems within the prior 90 days was an independent risk factor for the development of CRKP BSIs. The non-susceptibility of CRKP isolates to more tested carbapenems and a higher mortality rate were found in the CRKP BSI group.

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“…However, initial CT scanning provides important information on the range of inflammation and other accompanying complications to help to establish a precise diagnosis. The use of a multiphase CT protocol (pre-and post-contrast) has been widespread in current practice in APN [2][3][4][5]. Recently, Taniguchi et al suggested that unenhanced Patients with Acute Pyelonephritis without Obstructive Uropathy and excretory CT phases are not really necessary because CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase [6].…”

Section: Introductionmentioning

confidence: 99%

The Usefulness of the Interpretation of Initial Plain CT Scan in Hospitalized Patients with Acute Pyelonephritis without Obstructive Uropathy

Sejima¹

2019

IJIDT

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To investigate the association between plain computed tomography (CT) findings and clinical characteristics and to characterize the potential factors affecting the disease outcome in hospitalized patients with acute pyelonephritis (APN) without obstructive uropathy, we reviewed our clinical database retrospectively. Five plain CT scan abnormal kidney findings of perirenal fat stranding, thickening of perirenal fasciae, kidney enlargement, dilation of renal pelvis, and abnormal density of renal parenchyma were elucidated in 70 patients with APN without obstructive uropathy who were hospitalized. The association between CT scan findings and clinical characteristics were analyzed. Logistic regression analysis was performed to characterize the potential factors that affect the period until the patient was afebrile using various clinical factors and five defined CT scan findings. Perirenal fat stranding and dilation of renal pelvis were significantly frequent in females and patients with diabetes mellitus. Serum inflammation markers were significantly deteriorated in patients with perirenal fat stranding, thickening of perirenal fasciae and kidney enlargement compared to patients with normal findings. An age-adjusted Charlson comorbidity index ≥ 5 and low serum albumin values were significantly associated with a prolonged febrile period. In conclusion, although abnormal plain CT scan findings at diagnosis are associated with some clinical characteristics, the patient's intrinsic factors are more useful for predicting the disease outcome in hospitalized patients with APN without obstructive uropathy.

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Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due toEscherichia coli

Abstract: On CT, urothelial thickening, diffuse peritoneal thickening, cystitis, and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E. coli.

Cited by 8 publications

References 25 publications

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

Comparison of bloodstream and non-bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae in the intensive care unit: a 9-year respective study

The Usefulness of the Interpretation of Initial Plain CT Scan in Hospitalized Patients with Acute Pyelonephritis without Obstructive Uropathy

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