Useful Predictive Factors for Bacteremia among Outpatients with Pyelonephritis
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- Nakamura Nobuhiro
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan
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- Uehara Yuki
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan Department of Infection Control Science, Juntendo University Graduate School of Medicine, Japan
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- Fukui Sayato
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan
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- Fujibayashi Kazutoshi
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan
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- Yokokawa Hirohide
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan
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- Naito Toshio
- Department of General Medicine, Juntendo University Faculty of Medicine, Japan Department of Infection Control Science, Juntendo University Graduate School of Medicine, Japan
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抄録
<p>Objective The aim of this study was to identify predictive factors for bacteremia conveniently and quickly among outpatients diagnosed with pyelonephritis. </p><p>Patients All patients who were diagnosed with pyelonephritis at the outpatient clinic in the Department of General Medicine of Juntendo University Hospital from April 1, 2008, to June 30, 2015, were enrolled. Patients from whom blood cultures had not been taken were excluded. </p><p>Methods Clinical information was extracted from medical charts. Factors potentially predictive of bacteremia were analyzed using a t-test and Fisher's exact test, followed by a multivariable logistic regression model analysis. </p><p>Results Blood cultures were drawn from 116 patients, and 25 (22%) presented with bacteremia. A multivariate analysis with the age, chills, platelet count and urine nitrite test results revealed that older age, positive urinary nitrite test results and chills tended to be associated with bacteremia, respectively. [older age: unit odds ratio (OR) 1.02, p=0.052, 95% confidence interval (CI) 1.00-1.05, positive urinary nitrite test findings: OR 2.5, p=0.092, 95% CI 0.86-7.7, chills: OR 2.5, p=0.096, 95% CI 0.84-7.65]. The area under the receiver operating characteristic (ROC) curve of this model was 0.77. Regardless of age, positive urinary nitrite test findings were significantly associated with bacteremia (OR 3.1, p=0.033, 95% CI 1.1-9.2), and chills tended to be associated with bacteremia (OR 2.7, p=0.07, 95% CI 0.93-7.9) The area under the ROC curve of this model was 0.75. </p><p>Conclusion Bacteremia should be considered in pyelonephritis patients with rapidly assessable factors in outpatient clinic. In particular, a model including a urinary nitrite test has the potential to aid in the prediction of bacteremia. </p>
収録刊行物
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- Internal Medicine
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Internal Medicine 57 (10), 1399-1403, 2018-05-15
一般社団法人 日本内科学会