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

Area of Science:

• Radiology
• Urology
• Infectious Disease

Background:

• Acute pyelonephritis (AP) is a severe kidney infection that can lead to fatal septic shock.
• Urolithiasis (kidney stones) is a common cause of AP, increasing the risk of complications.
• Predicting bacteremia in AP patients is crucial for timely and effective treatment.

Purpose of the Study:

• To assess the utility of excretory phase computed tomography (CT) in predicting bacteremia.
• To identify risk factors for bacteremia in patients with AP and upper urinary tract calculi.
• To correlate imaging findings with clinical outcomes.

Main Methods:

• Retrospective review of 250 AP patients with upper urinary tract calculi.
• Analysis of excretory phase CT scans (7 min post-contrast) in 132 patients.
• Univariate and multivariate analyses to identify bacteremia risk factors, including obstruction grade and quick Sepsis-related Organ Failure Assessment (qSOFA) score.

Main Results:

• Bacteremia was present in 55.3% of analyzed patients.
• High-grade obstruction on excretory phase CT (OR 6.68) and qSOFA score ≥ 2 (OR 3.59) were independent predictors of bacteremia.
• Escherichia coli was the most common pathogen; vasopressor use was significantly associated with bacteremia.

Conclusions:

• Excretory phase CT is a valuable tool for predicting bacteremia in AP patients with calculi.
• The degree of ureteral obstruction visualized on excretory phase CT is critical for risk stratification.
• Imaging assessment of urine passage aids in managing AP associated with upper urinary tract stones.