Korean Journal of Nephrology 2009;28(5):418-423.
Clinical Risk Factors for Bacteremia in Patients with Acute Pyelonephritis
Seun Duk Hwang, M.D., Kyoung Suk Park, M.D., Byung Soo Jeon, M.D., Yoon Ji Kim, M.D., Sang Hun Lee, M.D, Kkot Sil Lee, Soo Young Yoon, M.D. and Sang Choel Lee, M.D.
Department of Internal Medicine, College of Medicine, Kwandong University, Goyang, Korea
임상연구 : 급성신우신염 환자에서 균혈증의 위험 인자 분석 - 단일기관 분석
황선덕, 박경석, 전병수, 김윤지, 이상헌, 이꽃실, 윤수영, 이상철
관동대학교 의과대학 내과학교실
Purpose:Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. Methods:One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. Results:Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p= 0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. Conclusion:Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.
Key Words: Pyelonephritis, Bacteremia, Urinary tract infection

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