title: Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis.
abstract: BACKGROUND
  The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients.
  
  
  METHODS
  We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011.
  
  
  RESULTS
  Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score ≥ 1, flank pain or azotemia were significantly more likely to have such structural abnormalities.
  
  
  CONCLUSIONS
  Blood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality. Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.
authors.affiliation: Center for Infectious Disease, National Medical Center, Seoul, Korea.
authors.forename: Yeonjae
authors.identifier: http://orcid.org/0000-0003-4144-9077
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Mi Ran
authors.initials: MR
authors.lastname: Seo
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Seong Jong
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Seong Heon
authors.initials: SH
authors.lastname: Wie
authors.affiliation: Department of Internal Medicine, Gil Hospital, Gacheon University, Incheon, Korea.
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Seung Kwan
authors.initials: SK
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Jin Seo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.
authors.forename: Hyuck
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Cheong
authors.affiliation: Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Gyemyeong University Hospital, Daegu, Korea.
authors.forename: Seong Yeol
authors.initials: SY
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Moon Hyun
authors.initials: MH
authors.lastname: Chung
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea. paihj@hanyang.ac.kr.
authors.forename: Hyunjoo
authors.identifier: http://orcid.org/0000-0003-4143-035X
authors.initials: H
authors.lastname: Pai
keywords: Blood culture; Diagnostic imaging; Pyelonephritis; Tomography scanners X-ray computed; Ultrasonography