Can excretory phase computed tomography predict bacteremia in obstructive calculous pyelonephritis?

Purpose Acute pyelonephritis (AP), a complication of urolithiasis, can be fatal if it progresses to septic shock. We aimed to evaluate the performance of excretory phase computed tomography (CT) in predicting bacteremia among AP patients with upper urinary tract calculi. Methods We reviewed medical...

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Bibliographic Details
Published in:International urology and nephrology 2018-12, Vol.50 (12), p.2123-2129
Main Authors: Yagihashi, Yusuke, Shimabukuro, Shuichi, Toyosato, Tomotune, Arakaki, Yoshitaka
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Bacteremia
Bacteremia - etiology
Bacteremia - microbiology
Computed tomography
Female
Humans
Kidney Calculi - complications
Kidney Calculi - diagnostic imaging
Lithiasis
Male
Medical records
Medicine
Medicine & Public Health
Middle Aged
Multivariate analysis
Nephrology
Predictive Value of Tests
Pyelonephritis
Pyelonephritis - diagnostic imaging
Pyelonephritis - etiology
Risk Factors
Sepsis
Septic shock
Tomography
Tomography, X-Ray Computed - methods
Ureteral Obstruction - complications
Ureteral Obstruction - diagnostic imaging
Urinary tract
Urine
Urogenital system
Urology
Urology - Original Paper
Vasoconstrictor Agents - therapeutic use
Young Adult
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Summary:Purpose Acute pyelonephritis (AP), a complication of urolithiasis, can be fatal if it progresses to septic shock. We aimed to evaluate the performance of excretory phase computed tomography (CT) in predicting bacteremia among AP patients with upper urinary tract calculi. Methods We reviewed medical records of 250 patients diagnosed with AP and upper urinary tract calculi and who were admitted to our institute. We analyzed 132 patients who underwent excretory phase CT. Excretory phase CT images were obtained 7 min after injection with the contrast agent. Obstruction was classified either as high or low grade. Univariate and multivariate analyses were performed to identify the risk factors of bacteremia. Results Of 132 patients, 73 (55.3%) had bacteremia. Escherichia coli was the most frequently identified pathogen in blood cultures. Univariate analysis demonstrated that high-grade obstruction on excretory phase CT and quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2 were correlated with bacteremia. In addition, the administration of vasopressors was significantly associated with bacteremia (31.5% vs. 6.8%; p  
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-018-1999-2