title: Febrile urinary tract infections: pyelonephritis and urosepsis.
abstract: OBJECTIVE
  Complicated infections of the urinary tract (UTI) including pyelonephritis and urosepsis are also called febrile UTI. This review describes insights from the literature on this topic since July 2014.
  
  
  RESULTS
  Recent studies regarding risk factors and consequences of febrile UTI confirmed existing knowledge. It remains difficult to obtain insight into the epidemiology of febrile UTI because urine and blood cultures are frequently missing. The relationship between host and virulence factors of Escherichia coli was further explored showing that less virulent strains can cause infection in immunocompromised patients. In contrast to obstructive uropathy, diabetes, and being older, neutropenia was not a risk factor for lower UTI or urosepsis. A randomized controlled trial revealed that ceftolozane-tazobactam was marginally superior to levofloxacin as treatment for complicated UTI. Case series supported the notion that xanthogranulomatous and emphysematous pyelonephritis are more common in diabetic patients and that drainage or surgery is often required.
  
  
  CONCLUSIONS
  Neutropenia was not a risk factor for lower UTI or urosepsis. When local resistance percentages to the frequently prescribed fluoroquinolones are high, the combination of ceftolozane-tazobactam may be an alternative as treatment for complicated UTI. Xanthogranulomatous and emphysematous pyelonephritis need to be considered in diabetic patients presenting with UTI symptoms.
authors.affiliation: aDepartment of Medical Microbiology, University of Amsterdam bDepartment of Internal Medicine cDepartment of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Schneeberger
authors.forename: Frits
authors.initials: F
authors.lastname: Holleman
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005334:Fever / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D064704:Levofloxacin / Q000627:therapeutic use; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011704:Pyelonephritis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000078142:Tazobactam; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000892:Anti-Infective Agents, Urinary; D002511:Cephalosporins; C000594038:ceftolozane, tazobactam drug combination; D064704:Levofloxacin; D010397:Penicillanic Acid; D000078142:Tazobactam