What are the guideline sources, guidelines and references for Acute pyelonephritis ?
Guideline sources The following summarized guidelines for the evaluation and management of acute pyelonephritis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the American College of Physicians (ACP 2021), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC 2017), the Infectious Diseases Society of America (IDSA 2016), and the Infectious Diseases Society of America (IDSA/ESCMID 2011). 1 2 3 4 5 6 6 7 8 8 Definition Acute pyelonephritis is a disease resulting from acute infection of the renal pelvis and kidney. 6 Epidemiology Acute pyelonephritis is caused by uropathogenic bacteria, including E. coli (80%), K. pneumoniae (6.2%), Enterococcus (5.3%), Streptococcus agalactiae (2.8%), P. mirabilis (2%), S. saprophyticus (1.4%), K. oxytoca (0.9%) and P. aeruginosa (0.8%). 8 Pathophysiology In the United States, the estimated incidence of acute pyelonephritis requiring hospitalization is 117 cases per 100,000 person-years among females, and 24 cases per 100,000 person-years among males. 7 Disease course https://web.pathway.md/diseases/recZ2NJmv4LxExl9z 1/5 6/23/23, 2:03 AM Acute pyelonephritis Pathway In patients with acute pyelonephritis, bacterial colonization and toxin production in the renal parenchyma leads to an inflammatory response and immune cell recruitment. Host-bacteria interaction leads to local tissue alterations (coagulation, epithelial breakdown, vascular leakage, and tissue destruction). Progression of infection may be associated with renal abscess, bacteremia, septic shock, and death. 8 Prognosis and risk of recurrence In patients with associated sepsis, mortality approaches 10-20%. 6 Calculator Pediatric Emergency Care Appli Guidelines 1. Screening and diagnosis Diagnostic criteria: diagnose acute pyelonephritis in women with compatible symptoms in whom urine cultures demonstrate 10 CFU/mL of a pathogenic organism. B 2. Diagnostic investigations Urine tests: As per EAU 2022 guidelines: Obtain urinalysis (using the dipstick method), including assessment of WBCs, RBCs, and nitrite, for the diagnosis of acute uncomplicated pyelonephritis. A Obtain urine culture and antimicrobial susceptibility testing in patients with pyelonephritis. A As per IDSA 2011 guidelines, obtain urine culture and susceptibility in patients with suspected pyelonephritis, and tailor initial empirical therapy according to urine culture results. B Blood cultures: consider obtaining blood cultures in patients with pyelonephritis, especially in patients with complicated infections or severe sepsis. C Urodynamic testing: obtain urological studies in patients with complicated acute pyelonephritis. B Show 2 more Urinary tract imaging: obtain urinary tract imaging to exclude urgent urological disorders. A https://web.pathway.md/diseases/recZ2NJmv4LxExl9z 2/5 6/23/23, 2:03 AM Acute pyelonephritis Pathway 3. Medical management Setting of care: consider treating women with uncomplicated acute pyelonephritis and mild-to- moderate symptoms (fever < 39 C, no severe flank pain, no vomiting) as outpatients. B Route of administration: administer parenteral antibiotic treatment as initial therapy for patients requiring hospital admission for acute pyelonephritis. B Empiric antibiotics, community-acquired pyelonephritis: As per EAU 2022 guidelines, administer short-course fluoroquinolones as first-line therapy in patients with uncomplicated pyelonephritis not requiring hospitalization. A Show 2 more As per SEIMC 2017 guidelines, use cefuroxime or a third-generation cephalosporin for the empiric treatment of patients with uncomplicated community-acquired acute pyelonephritis in whom there are no specific risk factors for ESBL-producing Enterobacteriaceae. B Show 2 more Updated evidence: ALLIUM In adult patients with a clinical diagnosis of complicated UTI or acute pyelonephritis caused by Gram-negative urinary pathogens, cefepime/enmetazobactam was superior to piperacillin/tazobactam with respect to overall treatment success at day 14. Keith S Kaye et al. JAMA. 2022 Oct 4. Empiric antibiotics (healthcare-associated pyelonephritis): use an antipseudomonal carbapanem as initial treatment for patients with healthcare-associated acute pyelonephritis. B Show 3 more Definitive therapy: As per SEIMC 2017 guidelines, tailor antibiotic treatment according to antibiotic susceptibility testing, once available, and select the agent with the least ecological impact, such as TMP- sulfamethoxazole, among agents to which the infecting pathogen is susceptible. B As per IDSA 2011 guidelines: Use oral TMP-sulfamethoxazole as definitive therapy for acute pyelonephritis, if the uropathogen is known to be susceptible. A Ensure an initial intravenous dose of a long-acting parenteral antimicrobial is given, such as 1 g of ceftriaxone, in patients in whom definitive therapy with oral -lactams is chosen. B Duration of treatment: As per ACP 2021 guidelines, complete a short-course of antibiotic therapy in male and female patients with uncomplicated pyelonephritis with one of the following regimens based on antibiotic susceptibility: fluoroquinolones for 5-7 days https://web.pathway.md/diseases/recZ2NJmv4LxExl9z 3/5 6/23/23, 2:03 AM Acute pyelonephritis Pathway TMP-sulfamethoxazole for 14 days. B As per SEIMC 2017 guidelines, 5 days in patients treated with aminoglycosides. B Show 3 more Landmark trials: Ciprofloxacin for 7 vs. 14 days in pyelonephritis In non-pregnant women with acute pyelonephritis, treatment with ciprofloxacin for 7 days were noninferior to treatment with ciprofloxacin for 14 days with respect to a short-term clinical cure. Sandberg T et al. Lancet. 2012 Aug 4. 4. Specific circumstances Pregnant patients: Consider managing pregnant women with otherwise uncomplicated acute pyelonephritis and non-severe symptoms in the outpatient setting, if appropriate follow-up can be ensured. B Obtain abdominal ultrasound and ensure results are normal before discharging pregnant women with uncomplicated acute pyelonephritis. B Patients with urosepsis: use the Quick SOFA score to identify patients with potential sepsis. A Show 5 more Patients with complicated pyelonephritis: Administer any of the following regimens as empirical therapy in patients with complicated pyelonephritis with systemic symptoms: amoxicillin and an aminoglycoside second-generation cephalosporin and an aminoglycoside IV third-generation cephalosporin. A Show 3 more Patients with Candida pyelonephritis: initiate oral fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks in patients with ascending Candida pyelonephritis caused by fluconazole-susceptible organisms. B Show 5 more References 1. de Cueto M, Aliaga L, Al s JI et al. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases SEIMC . Enferm Infecc Microbiol Clin. 2017 May;35 5 314 320. Open 2. Gupta K, Hooton TM, Naber KG et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of https://web.pathway.md/diseases/recZ2NJmv4LxExl9z 4/5 6/23/23, 2:03 AM Acute pyelonephritis Pathway America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52 5):e103 20. Open 3. G. Bonkat, R. Bartoletti, F. Bruy re et al. EAU Guidelines on Urological Infections. EAU. 2022. Open 4. Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62 4):e1 50. Open 5. Rachael A Lee, Robert M Centor, Linda L Humphrey et al. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Ann Intern Med. 2021 Apr 6. Open 6. Johnson JR, Russo TA. Acute Pyelonephritis in Adults. N Engl J Med. 2018 Jan 4;378 1 48 59. Open 7. Lee DG, Jeon SH, Lee CH et al. Acute pyelonephritis: clinical characteristics and the role of the surgical treatment. J Korean Med Sci. 2009 Apr;24 2 296 301. Open 8. Choong FX, Antypas H, Richter-Dahlfors A. Integrated Pathophysiology of Pyelonephritis. Microbiol Spectr. 2015 Oct;3 5 . Open 9. Keith S Kaye, Adam Belley, Philip Barth et al. Effect of Cefepime/Enmetazobactam vs Piperacillin/Tazobactam on Clinical Cure and Microbiological Eradication in Patients With Complicated Urinary Tract Infection or Acute Pyelonephritis: A Randomized Clinical Trial. JAMA. 2022 Oct 4;328 13 1304 1314. 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