Risk factors for the development of acute pyelonephritis in women with a positive urine culture

Abstract

Introduction: In treating lower urinary tract symptoms (LUTS), the risk of overtreatment with antibiotics must be reconciled with the risk of an untreated urinary tract infection (UTI) progressing to acute pyelonephritis (APN). Using Cerner HealthFacts, a longitudinal clinical informatics database, we aimed to determine risk factors associated with the development of APN from UTI in an effort to guide the initiation of empiric antibiotics. Methods: We queried the Cerner HealthFacts database for women over age 18 with a positive urine culture. Any patient with an International Classification of Disease (ICD) code indicating chronic pyelonephritis was excluded. Development of APN within 30 days of the positive culture, specified by ICD coding, was our primary outcome. Patient and facility factors were assessed as potential risk factors for the development of APN using multivariable regression. Results: Out of 58 344 women with a positive urine culture, 3.9% (2296) developed APN. Mean patient age was 54.4 ± 25.3 years. Overall, 12 variables were predictive for APN and 11 variables were protective against APN.Presence of obstructive and reflux uropathies (OR 4.58), presentation to an acute care facility (OR 3.19), urinary retention (OR 2.30), history of UTI (OR 2.19), and renal comorbidities (OR 2.07) conferred the highest odds of APN development. The most protective variable against APN development was cognitive impairment (OR 0.49).Conclusions: Identified risk factors associated with APN development may aid decisions regarding empiric antibiotic initiation for patients presenting with LUTS while awaiting urine culture results. The relationship between cognitive impairment and progression to APN deserves further study.

A Diagnostic Test Combining Molecular Testing with Phenotypic Pooled Antibiotic Susceptibility Improved the Clinical Outcomes of Patients with Non-E. coli or Polymicrobial Complicated Urinary Tract Infections

“…The lack of accurate and rapid directed treatment of cUTIs presents a significant healthcare problem, causing a higher risk of treatment failure, persistence, increasing severity, progression to acute pyelonephritis, recurrence and urosepsis. 4,26 Increased ED and hospitalization visits, along with urosepsis (which is responsible for 25% of sepsis cases), causes increased healthcare cost and significant patient morbidity. These indicate a strong need for more accurate…”

Comparison Shows that Multiplex Polymerase Chain Reaction Identifies Infection-associated Urinary Biomarker–positive Urinary Tract Infections That Are Missed by Standard Urine Culture

“…The development of accurate and rapid diagnostic testing presents an opportunity to improve antibiotic stewardship and reduce health care costs by optimizing directed treatment and reducing empiric antibiotic use [24] , [25] . Previous retrospective studies have demonstrated that approximately $64 239 in health care expenditures is averted when a single patient avoids hospitalization and/or emergency department visits for a UTI [26] , and that the use of M-PCR/P-AST testing to guide management of UTIs was associated with a 13.7% decrease in hospital admissions and/or emergency department utilization when compared with the use of SUC testing ( p = 0.003) [9] .…”

The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections

“…9 As the threat of microbial antibiotic resistance continues to increase, providing the correct antibiotic treatment quickly enough to avoid prolonged empiric therapy is a growing concern among healthcare stakeholders. [10][11][12][13] As a diagnostic test for UTI, standard urine culture (SUC) has been in use for over 60 years with little advancement to accommodate for the identification of more recently discovered emerging uropathogens. 14 The standard urine culture method is optimized for the growth of gram-negative bacteria, primarily Escherichia coli (E. coli), the most commonly identified organism in acute UTIs.…”