Acute Pyelonephritis in Adults

Authors:
  • APAngelos V. Pefanis
    Angelos V. Pefanis
  • DTDimitrios I. Tsioulos
    Dimitrios I. Tsioulos
  • IZIoannis D. Zacharos
    Ioannis D. Zacharos
  • ATAphrodite G. Tsiakou
    Aphrodite G. Tsiakou
  • AMAthanasios G. Mitromaras
    Athanasios G. Mitromaras
  • SMStylianos E. Mastorantonakis
    Stylianos E. Mastorantonakis
  • SKSophie N. Kanavaki
    Sophie N. Kanavaki
  • TMTheodore D. Mountokalakis
    Theodore D. Mountokalakis
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Abstract
ACUTE INFECTION of the upper urinary tract (acute pyelonephritis [AP]) occurs in at least 250 000 adults per year in the United States,1 representing the most severe form of urinary tract infection (UTI).2,3 It often requires hospitalization and prolonged therapy, and when accompanied by bacteremia, AP has a mortality rate of 10% to 20%.4,5 Efforts to provide emergency department physicians with simple tools for the prediction of antimicrobial resistance and risk for death are justified by the increasing prevalence of resistance of various uropathogens to combined trimethoprim and sulfamethoxazole, β-lactams, and fluoroquinolones (FQs)6 and the finding in different clinical studies that almost half of the patients who were initially empirically treated with antibiotics received inappropriate treatment.7 Although numerous studies have focused on antimicrobial resistance of bacteria that cause UTIs in general,8-11 data on the ability to predict mortality and failure of treatment due to resistant pathogens in patients with AP are lacking. Moreover, despite the fact that AP in women has been extensively studied, scant information regarding AP in men exists.12,13

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