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成人急性肾盂肾炎
Acute Pyelonephritis in Adults


James R. Johnson ... 其他 • 2018.01.04

本刊的这一栏目首先提供一份强调某一常见临床问题的病例摘要,然后提出支持各种策略的证据。如果有正式指南,作者接下来会对其进行综述。文章以作者的临床建议结尾。

 

一名平日身体健康的35岁女性因尿急、排尿困难、发热、不适、恶心和胁痛就诊。她在近期 一次去印度的旅行中因腹泻服用了一种氟喹诺酮类药物。她的体检结果:体温为38.6,脉搏为110次/分,血压为105/50 mmHg;有耻骨上压痛和胁压痛,无腹部压痛。白细胞计数为16,500/mm3,血清肌酐浓度为1.4 mg/dL(124 μmol/L)就诊前最近一次测定值为0.8 mg/dL [71 μmol/L]。尿液分析呈白细胞酯酶和硝酸盐阳性。您如何评估和管理此病例?





作者信息

James R. Johnson, M.D., and Thomas A. Russo, M.D., C.M.
From Minneapolis Veterans Affairs (VA) Health Care System and the University of Minnesota, Minneapolis (J.R.J.); and the University of Buffalo, State University of New York, and VA Western New York Health Care System, Buffalo (T.A.R.). Address reprint requests to Dr. Johnson at Minneapolis VA Health Care System, 1 Veterans Dr., Infectious Diseases 111F, Minneapolis, MN 55417, or at johns007@umn.edu.

 

参考文献

1. Talan DA, Takhar SS, Krishnadasan A, Abrahamian FM, Mower WR, Moran GJ. Fluoroquinolone-resistant and extended-spectrum β-lactamase-producing Escherichia coli infections in patients with pyelonephritis, United States. Emerg Infect Dis 2016;22:1594-1603

2. van Nieuwkoop C, van der Starre WE, Stalenhoef JE, et al. Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women. BMC Med 2017;15:70-70

3. Ulleryd P, Sandberg T. Ciprofloxacin for 2 or 4 weeks in the treatment of febrile urinary tract infection in men: a randomized trial with a 1 year follow-up. Scand J Infect Dis 2003;35:34-39

4. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-810

5. Piccoli GB, Consiglio V, Colla L, et al. Antibiotic treatment for acute ‘uncomplicated’ or ‘primary’ pyelonephritis: a systematic, ‘semantic revision.’ Int J Antimicrob Agents 2006;28:Suppl 1:S49-S63

6. Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 2008;71:17-22

7. Cronberg S, Banke S, Bergman B, et al. Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime. Scand J Infect Dis 2001;33:339-343

8. Owens RC Jr, Johnson JR, Stogsdill P, Yarmus L, Lolans K, Quinn J. Community transmission in the United States of a CTX-M-15-producing sequence type ST131 Escherichia coli strain resulting in death. J Clin Microbiol 2011;49:3406-3408

9. Velasco M, Martínez JA, Moreno-Martínez A, et al. Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary? Clin Infect Dis 2003;37:1127-1130

10. Kim Y, Seo MR, Kim SJ, et al. Usefulness of blood cultures and radiologic imaging studies in the management of patients with community-acquired acute pyelonephritis. Infect Chemother 2017;49:22-30

11. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007;45:273-280

12. Ki M, Park T, Choi B, Foxman B. The epidemiology of acute pyelonephritis in South Korea, 1997-1999. Am J Epidemiol 2004;160:985-993

13. Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016;65:1-122

14. Lagu T, Rothberg MB, Shieh M-S, Pekow PS, Steingrub JS, Lindenauer PK. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med 2012;40:754-761

15. Brown P, Ki M, Foxman B. Acute pyelonephritis among adults: cost of illness and considerations for the economic evaluation of therapy. Pharmacoeconomics 2005;23:1123-1142

16. Schrock JW, Reznikova S, Weller S. The effect of an observation unit on the rate of ED admission and discharge for pyelonephritis. Am J Emerg Med 2010;28:682-688

17. Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med 2005;142:20-27

18. Ikäheimo R, Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis 1996;22:91-99

19. Godaly G, Ambite I, Svanborg C. Innate immunity and genetic determinants of urinary tract infection susceptibility. Curr Opin Infect Dis 2015;28:88-96

20. Stamm WE, Hooton TM, Johnson JR, et al. Urinary tract infections: from pathogenesis to treatment. J Infect Dis 1989;159:400-406

21. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial. JAMA 2000;283:1583-1590

22. Johnson JR, Lyons MFI II, Pearce W, et al. Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days. J Infect Dis 1991;163:325-330

23. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int 2011;107:1474-1478

24. Johnson JR, Porter S, Thuras P, Castanheira M. The pandemic H30 subclone of sequence type 131 (ST131) as the leading cause of multidrug-resistant Escherichia coli infections in the United States (2011-2012). Open Forum Infect Dis 2017;4:ofx089-ofx089

25. Jackson GG, Grieble HG, Knudsen KB. Urinary findings diagnostic of pyelonephritis. J Am Med Assoc 1958;166:14-17

26. Platt R. Quantitative definition of bacteriuria. Am J Med 1983;75:1B:44-52

27. Long B, Koyfman A. Best clinical practice: blood culture utility in the emergency department. J Emerg Med 2016;51:529-539

28. van Nieuwkoop C, Hoppe BP, Bonten TN, et al. Predicting the need for radiologic imaging in adults with febrile urinary tract infection. Clin Infect Dis 2010;51:1266-1272

29. 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 America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-e120

30. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304-377

31. Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet 2012;380:484-490

32. Sanchez M, Collvinent B, Miró O, et al. Short-term effectiveness of ceftriaxone single dose in the initial treatment of acute uncomplicated pyelonephritis in women: a randomised controlled trial. Emerg Med J 2002;19:19-22

33. Monmaturapoj T, Montakantikul P, Mootsikapun P, Tragulpiankit P. A prospective, randomized, double dummy, placebo-controlled trial of oral cefditoren pivoxil 400 mg once daily as switch therapy after intravenous ceftriaxone in the treatment of acute pyelonephritis. Int J Infect Dis 2012;16:e843-e849

34. Jernelius H, Zbornik J, Bauer CA. One or three weeks’ treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam. Acta Med Scand 1988;223:469-477

35. Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy: IDSA guidelines. Clin Infect Dis 2004;38:1651-1672

36. Talan DA, Klimberg IW, Nicolle LE, Song J, Kowalsky SF, Church DA. Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis. J Urol 2004;171:734-739

37. Naber KG, Bartnicki A, Bischoff W, et al. Gatifloxacin 200 mg or 400 mg once daily is as effective as ciprofloxacin 500 mg twice daily for the treatment of patients with acute pyelonephritis or complicated urinary tract infections. Int J Antimicrob Agents 2004;23:Suppl 1:S41-S53

38. Eliakim-Raz N, Yahav D, Paul M, Leibovici L. Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection — 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2013;68:2183-2191

39. Kyriakidou KG, Rafailidis P, Matthaiou DK, Athanasiou S, Falagas ME. Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials. Clin Ther 2008;30:1859-1868

40. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics 2008;28:255-277, 327-8

41. Rubenstein JN, Schaeffer AJ. Managing complicated urinary tract infections: the urologic view. Infect Dis Clin North Am 2003;17:333-351

42. Jolley JA, Wing DA. Pyelonephritis in pregnancy: an update on treatment options for optimal outcomes. Drugs 2010;70:1643-1655

43. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2015:CD000490-CD000490

44. Singh R, Geerlings SE, Bemelman FJ. Asymptomatic bacteriuria and urinary tract infections among renal allograft recipients. Curr Opin Infect Dis 2015;28:112-116

45. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil 1995;76:272-280

46. Tchesnokova V, Avagyan H, Rechkina E, et al. Bacterial clonal diagnostics as a tool for evidence-based empiric antibiotic selection. PLoS One 2017;12:e0174132-e0174132

47. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin Infect Dis 1999;29:745-758

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