Title: Diagnosis and Treatment of Acute Pyelonephritis in Women - American Family Physician
Headings: Diagnosis and Treatment of Acute Pyelonephritis in Women
Diagnosis and Treatment of Acute Pyelonephritis in Women
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Epidemiology
MICROBIOLOGY
Causative Organisms in Acute Pyelonephritis
ANTIBIOTIC RESISTANCE
RISK FACTORS
COMPLICATED VS. UNCOMPLICATED ACUTE PYELONEPHRITIS
Clinical Diagnosis
Clinical and Laboratory Findings in Patients with Acute Pyelonephritis
Diagnoses to Consider in Patients with Flank Pain and Costovertebral Angle Tenderness
Complications of Acute Pyelonephritis That May Benefit from Subspecialty Consultation
Inpatient vs. Outpatient Treatment
Considerations for Hospitalization in Patients with Acute Pyelonephritis
Diagnostic Tests
URINALYSIS
URINE CULTURE
IMAGING
Enlarge Print
BLOOD CULTURES
OTHER DIAGNOSTIC TESTS
Choice of Antibiotics
OUTPATIENT REGIMENS
Outpatient Treatment Options for Nonpregnant Women with Acute Pyelonephritis
INPATIENT REGIMENS
Initial and Step-Down Inpatient Treatment Options for Nonpregnant Women with Acute Pyelonephritis
Monitoring Response to Therapy

Content: The spectrum of pathogens involved in acute pyelonephritis is similar to that of cystitis but with a lower frequency of Staphylococcus saprophyticus ( Table 1 4). Enlarge Print
Table 1. Causative Organisms in Acute Pyelonephritis
Organism
Prevalence (%)
Escherichia coli
82 (women)

73 (men)
Klebsiella pneumoniae
2.7 (women)

6.2 (men)
Staphylococcus saprophyticus
< 3 (women)
Candida species
Rare
Enterococcus species
Rare
Other Enterobacteriaceae (e.g., Proteus species, Enterobacter species)
Rare
Pseudomonas aeruginosa
Rare
Ureaplasma species
Rare
Information from reference 4. Table 1. Causative Organisms in Acute Pyelonephritis
Organism
Prevalence (%)
Escherichia coli
82 (women)

73 (men)
Klebsiella pneumoniae
2.7 (women)

6.2 (men)
Staphylococcus saprophyticus
< 3 (women)
Candida species
Rare
Enterococcus species
Rare
Other Enterobacteriaceae (e.g., Proteus species, Enterobacter species)
Rare
Pseudomonas aeruginosa
Rare
Ureaplasma species
Rare
Information from reference 4. ANTIBIOTIC RESISTANCE
During the previous decade, community-acquired bacteria (particularly E. coli) that produce extended-spectrum beta-lactamases have emerged as a cause of acute pyelonephritis worldwide. The most common risk factors for contracting these uropathogens include visits to health care centers, recent use of antimicrobial agents (particularly cephalosporins and fluoroquinolones), older age, and presence of comorbid conditions, such as diabetes mellitus and recurrent urinary tract infections (UTIs). 6 – 9
RISK FACTORS
Risk factors for acute pyelonephritis in nonpregnant women include sexual intercourse three or more times per week during the previous 30 days, UTIs in the previous 12 months, diabetes, stress incontinence in the previous 30 days, a new sex partner in the previous year, recent spermicide use, and a history of UTIs in the patient's mother. 4, 5, 10 Older women, women who are menopausal or pregnant, and women who have preexisting urinary tract structural abnormalities or obstructions have a higher risk of UTI, but not necessarily of acute pyelonephritis. 5, 6
COMPLICATED VS.