Useful Predictive Factors for Bacteremia among Outpatients with Pyelonephritis

Abstract

Objective The aim of this study was to identify predictive factors for bacteremia conveniently and quickly among outpatients diagnosed with pyelonephritis. Patients All patients who were diagnosed with pyelonephritis at the outpatient clinic in the Department of General Medicine of Juntendo University Hospital from April 1, 2008, to June 30, 2015, were enrolled. Patients from whom blood cultures had not been taken were excluded. Methods Clinical information was extracted from medical charts. Factors potentially predictive of bacteremia were analyzed using a t-test and Fisher's exact test, followed by a multivariable logistic regression model analysis. Results Blood cultures were drawn from 116 patients, and 25 (22%) presented with bacteremia. A multivariate analysis with the age, chills, platelet count and urine nitrite test results revealed that older age, positive urinary nitrite test results and chills tended to be associated with bacteremia, respectively. [older age: unit odds ratio (OR) 1.02, p=0.052, 95% confidence interval (CI) 1.00-1.05, positive urinary nitrite test findings: OR 2.5, p=0.092, 95% CI 0.86-7.7, chills: OR 2.5, p=0.096, 95% CI 0.84-7.65]. The area under the receiver operating characteristic (ROC) curve of this model was 0.77. Regardless of age, positive urinary nitrite test findings were significantly associated with bacteremia (OR 3.1, p=0.033, 95% CI 1.1-9.2), and chills tended to be associated with bacteremia (OR 2.7, p=0.07, 95% CI 0.93-7.9) The area under the ROC curve of this model was 0.75. Conclusion Bacteremia should be considered in pyelonephritis patients with rapidly assessable factors in outpatient clinic. In particular, a model including a urinary nitrite test has the potential to aid in the prediction of bacteremia.

A positive nitrite test was an independent risk factor for invasive bacterial infections in infants under 90 days of age with fever without source

“…This was regardless of the presence or absence of a positive leucocyte test. Similar results were obtained in an adult study 11 …”

“…Similar results were obtained in an adult study. 11 UTI is the most common serious bacterial infection in febrile young infants. 1,2 A definitive diagnosis of UTI is based on a positive urine culture result.…”

“…The presence of a positive result for nitrite and leucocyte esterase on urinalysis has been proven to be an independent risk factor for bacteraemia in young febrile infants, 8‐10 but little is known about the specific value of the nitrite test. One study showed that a model that included the urinary nitrite test may be useful for predicting bacteraemia among adult patients with pyelonephritis 11 . This suggests that this procedure could be used in the infant population.…”

“…One study showed that a model that included the urinary nitrite test may be useful for predicting bacteraemia among adult patients with pyelonephritis. 11 This suggests that this procedure could be used in the infant population.…”

Clinical prediction rule for bacteremia with pyelonephritis and hospitalization judgment: chi-square automatic interaction detector (CHAID) decision tree analysis model

“… 7 Furthermore, other preliminary research has indicated that older age, positive urinary nitrite test results, and chills tend to be seen in patients with pyelonephritis accompanied by bacteremia. 8 However, the quick Sequential Organ Failure Assessment (qSOFA), which is now widely used, was not incorporated as part of this preliminary research. 9 Furthermore, a score classification system for recommendation of hospitalization does not exist for patients with pyelonephritis, in contrast to our experience with other diseases (e.g., CURB-65 for patients with pneumonia).…”