Predicting the Need for Radiologic Imaging in Adults with Febrile Urinary Tract Infection

Nieuwkoop, Cees van; Hoppe, Bart P.C.; Bonten, Tobias N; Wout, J. W. Van’t; Aarts, N. J. M.; Mertens, Bart; Leyten, Eliane M. S.; Koster, Ted; Wattel-Louis, G Hanke; Delfos, Nathalie M; Ablij, Hans C; Elzevier, Henk W.; Dissel, Jaap T. van

doi:10.1086/657071

Cited by 57 publications

(38 citation statements)

References 30 publications

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“…The more difficult to treat bacteria such as Pseudomonas aeruginosa or even rarities such as Salmonella typhi may cause treatment failure in primary calculated antibiotic therapy of OPN [14,15]. We agree with van Nieuwkoop et al [16] that imaging is necessary in patients with febrile UTI in the presence of a history of urolithiasis and/or a urine pH ≥7.0 and/or renal insufficiency (estimated glomerular filtration rate ≤40 ml/min/1.73 m 3 ).…”

Section: Discussionsupporting

confidence: 85%

Long-Term Results after Acute Therapy of Obstructive Pyelonephritis

et al. 2015

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Introduction: To evaluate therapeutic results till 5 years after therapy of obstructive pyelonephritis (OPN) emphasizing regular follow-up. Material and Methods: During 5 years, 57 patients with OPN were treated. The patients' charts were reviewed retrospectively for clinical data. These were completed by a questionnaire. Results: In the group of 57 patients (average age 56 years), about two third were women. Urolithiasis (65%) and tumors (21%) were the main causes of obstruction; fever (91%) and loin pain (86%) the main symptoms. Three fourth of the patients showed renal insufficiency and nearly 50% anemia. E. coli and Proteus spp. were the dominating organisms. Sonography detected obstruction in 93% cases. In one third of cases, CT scan was added; 81% percutaneous nephrostomy and 19% ureteral stenting were the initial methods of urinary drainage. During therapy, 23% nephrectomies (19% complete, 4% partial) were performed. Long-term follow-up showed 11% recurrent OPN and 33% recurrent UTI. Conclusions: After diagnosis of OPN, primary nephrostomy or ureteral stenting and antibiotic therapy are the first measures. If recurrent urinary tract infections or OPN occur, long-term follow-up and low-dose antibiotic prophylaxis may be discussed.

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Section: Discussionsupporting

confidence: 85%

Long-Term Results after Acute Therapy of Obstructive Pyelonephritis

et al. 2015

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“…Interestingly, more than a quarter of these patients had a urethral lithiasis that required drainage. Therefore, radiologic imaging should be indicated in males with a FUTI developing severe sepsis or a septic shock, particularly in those with urolithiasis, which has been recognised as a risk factor for complications [21].…”

Section: Discussionmentioning

confidence: 99%

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Smithson

Ramos

Bastida

et al. 2015

Eur J Clin Microbiol Infect Dis

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The objective of this study was to analyse the characteristics of healthcare-associated febrile urinary tract infection (HCA-FUTI) compared to community-acquired FUTI (CA-FUTI) in men. An ambispective cross-sectional study in which we recorded clinical and microbiology data and outcomes from males with FUTI attended in the Emergency Department was carried out. A total of 479 males with FUTI, 162 (33.8%) HCA-FUTI and 317 (66.2%) CA-FUTI, were included. HCA-FUTI patients were older (p < 0.001), had higher Charlson scores (p < 0.001) and received previous antimicrobial treatment more frequently (p < 0.001) compared to CA-FUTI patients. HCA-FUTI was less likely caused by Escherichia coli (p < 0.001) and more frequently by Klebsiella spp. (p = 0.02), Enterobacter spp. (p < 0.001) and Pseudomonas aeruginosa (p < 0.001). Resistance to ceftriaxone (p = 0.006), gentamicin (p < 0.001), quinolones (p < 0.001), co-trimoxazole (p = 0.001) and fosfomycin (p = 0.009) was higher among E. coli strains isolated from males with HCA-FUTI and so was the prevalence of extended-spectrum beta-lactamase and AmpC E. coli and Klebsiella spp.-producing strains (p = 0.012). Inadequate antimicrobial treatment and all-cause in-hospital mortality was associated with HCA-FUTI (p < 0.001 and p = 0.004, respectively). Independent factors for mortality were severe sepsis or septic shock [odds ratio (OR) 29; 95% confidence interval (CI): 3.9-214] and cirrhosis (OR 23.7; 95% CI: 1.6-350.6). Male patients with HCA-FUTI have different clinical characteristics, outcomes and microbiological features compared to CA-FUTI patients. Previous contact with the healthcare system has to be taken into consideration when deciding the optimal antimicrobial treatment in males with FUTI.

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“…22 A patient was considered febrile when the highest recorded tympanic temperature was >38.0 C on the day the blood culture was collected. 23 Kidney failure was defined as a creatinine level >1.5 mg/dL, 24 and co-morbid conditions (such as cirrhosis, diabetes, etc.) or immunocompromised status were ascertained according to the patient's medical records and Charlson's score; 25 these findings were reviewed by two infectious disease specialists.…”

Section: Case Definitionmentioning

confidence: 99%

Proteus mirabilis urinary tract infection and bacteremia: Risk factors, clinical presentation, and outcomes

Chen

et al. 2012

Journal of Microbiology, Immunology and Infection

136

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Predicting the Need for Radiologic Imaging in Adults with Febrile Urinary Tract Infection

Abstract: Radiologic imaging can selectively be applied in adults with febrile UTI without loss of clinically relevant information by using a simple clinical prediction rule.

Cited by 57 publications

References 30 publications

Long-Term Results after Acute Therapy of Obstructive Pyelonephritis

Long-Term Results after Acute Therapy of Obstructive Pyelonephritis

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Proteus mirabilis urinary tract infection and bacteremia: Risk factors, clinical presentation, and outcomes

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