BJU Int
Department of Urology, University of Innsbruck, Innsbruck, Austria.
Published: February 2008
Objective: To assess the value of contrast-enhanced ultrasonography (US) with the contrast pulse-sequence (CPS) technique for detecting renal parenchymal changes in acute pyelonephritis (APN), compared with contrast-enhanced computed tomography (CT) as the reference standard.
Patients And Methods: We examined 100 patients (82 women, 18 men; mean age 30.2 years, range 18-67); children (those aged <18 years) were excluded from the study. All patients had clinical symptoms suggestive of APN. For the US a Sequoia 512 (Acuson, Mountain View, CA, USA) unit including Cadence CPS technology, with a 6C2 probe, was used. A bolus of a 2.4-mL US contrast agent SonoVue (Bracco, Milan, Italy) was injected. For CT a multislice 16-row unit was used (Sensation 16, Siemens, Erlangen, Germany), at a table speed of 2.5 mm/s and a slice thickness of 3 mm; 100 mL of intravenous iodinated contrast agent (flow 3 mL/s) was injected.
Results: On contrast CT, 84 patients (84%) had renal parenchymal changes suggestive of APN; on contrast US, 82 of the 84 (98%) showed renal parenchymal changes, and APN was correctly diagnosed. Seventy-six patients (90%) had unilateral and eight (10%) had bilateral APN, and in two (2%) with APN the diagnosis could not be confirmed by US/CPS (false-negative). No false-positive findings were detected on US/CPS, which had a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 89%.
Conclusion: CPS/US is accurate for detecting parenchymal changes in APN; it is very sensitive and specific, and allows small renal parenchymal changes to be detected with no radiation exposure.
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http://dx.doi.org/10.1111/j.1464-410X.2007.07280.x | DOI Listing |
Antimicrob Steward Healthc Epidemiol
January 2025
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
Ambulatory antibiotic stewardship has traditionally focused on acute respiratory infections with few studies evaluating metrics for other commonly encountered ambulatory conditions, including urinary tract infections (UTI). We describe the development and validation of an electronically captured appropriate antibiotic use metric for ambulatory UTIs using coding data.
View Article and Find Full Text PDFAntimicrob Steward Healthc Epidemiol
July 2024
Cardinal Health Innovative Delivery Solutions, Stafford, TX, USA.
Objective: The aim of this study was to determine if oral beta-lactam therapy is non-inferior to alternative therapy at discharge following inpatient treatment with an IV cephalosporin for acute pyelonephritis.
Design: Institutional Review Board (IRB)-approved, multicenter, retrospective, non-inferiority cohort (15% non-inferiority margin).
Setting: Six hospitals within two healthcare systems.
J Comp Eff Res
January 2025
Advanz Pharma, London, UK.
Compared with uncomplicated urinary tract infections (UTIs), complicated UTIs (cUTIs) including acute pyelonephritis (AP) present with significant morbidity, a higher risk of treatment failure and typically require longer courses of treatment, or alternative antibiotics. The emergence of drug-resistant organisms represents a considerable challenge in the treatment of patients with cUTIs/AP and has limited antibiotic options. Carbapenems are considered the current last line of therapy, however, carbapenem resistance represents a growing problem.
View Article and Find Full Text PDFAccess Microbiol
January 2025
Department of Bacteriology, Mohammed V Military Teaching Hospital/Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco.
Bacterial urinary tract infections (UTIs) are common, ranging from benign cystitis to complicated pyelonephritis, which can lead to severe complications such as pyonephrosis and sepsis. Pyonephrosis, characterized by the presence of pus in the renal cavities, often requires urgent urological intervention. We report a unique case of pyonephrosis with a psoas abscess caused by and in a 64-year-old diabetic female patient.
View Article and Find Full Text PDFJ Clin Pharmacol
January 2025
Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
This study evaluates the impact of acute pyelonephritis in pregnant women on the in vivo activity of renal OAT3 using the endogenous biomarker (EB) 6β-hydroxycortisol (6β-OHF) renal clearance (CL 6β-OHF) and AUC validated by correlating with the secretion clearance (CL) of the probe drug furosemide. Additionally, 6β-OHF formation clearance (CL 6β-OHF) as well as urinary (Ae/Ae) and plasma (AUC/AUC) ratios were also evaluated as EB for hepatic CYP3A activity. Pregnant women in their third trimester of gestation, diagnosed with acute pyelonephritis, were recruited before (pre-treatment, n = 8) and after (post-treatment, n = 8) cefuroxime treatment and resolution of acute pyelonephritis.
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