Patients with complicated pyelonephritis requiring surgical interventions such as double-J stent insertion, suprapubic cystostomy, or nephrostomy are admitted to the Department of Urology. Adolescent and adult patients who are diagnosed with fUTI and who need to be hospitalized are admitted to the Division of Infectious Diseases. Most patients with a suspected fUTI are initially examined in the ER. Approximately 39,000 patients visit the emergency room (ER) annually and nearly 7,000 patients are hospitalized after attending the ER each year. This was a single hospital-based, retrospective observational study. On the basis of our findings, we recommend using urine PCGS to ensure a more precise fUTI diagnosis and to select narrower-spectrum antimicrobial agents. For each group, we investigated whether PCGS detected pyuria and bacteriuria, estimated bacterial types, and promoted narrower-spectrum antimicrobial use and effective treatment. In addition, fUTI patients were divided into uncomplicated and complicated groups because patients with complicated pyelonephritis are more likely to have AMR. The objective of this study was to clarify whether urine PCGS contributed to etiologic agent estimation and targeted treatment of fUTI in adults. However, the usefulness of PCGS in diagnosing and treating fUTI in adults has never been investigated, and its clinical impact remains unclear. Urine PCGS has been used here in children. Point-of-care Gram stain (PCGS) performed by clinicians has reduced broad-spectrum antimicrobial overuse at Okinawa Chubu Hospital (OCH) in Japan. Gram staining in clinical microbiology assists in diagnosing fUTI, while evidence for the fUTI treatment strategy is limited. Ceftriaxone, a third-generation cephalosporin, is commonly recommended as an empirical treatment for uncomplicated pyelonephritis, while carbapenems are recommended for complicated pyelonephritis because of the concern about an increase in extended-spectrum beta-lactamases (ESBLs). Febrile UTI diagnosis is not straightforward, and the treatment has become more complicated due to the increasing antimicrobial resistance (AMR). Urine PCGS led to a more precise fUTI diagnosis and prompted clinicians to select narrower-spectrum antibiotics with high susceptibility.įebrile urinary tract infections (fUTIs), which include acute pyelonephritis, prostatitis, and urosepsis, can cause sepsis, septic shock, and death. In the complicated group, the susceptibility was 84.2% (186/221) ( p = 0.009) despite frequent AMRs (14.7% 32/218) and low use of broad-spectrum antimicrobials such as carbapenems (7.7% 17/221). In the uncomplicated group, narrow-spectrum antimicrobials such as cefotiam were initially selected in 97.9% (47/48) of patients, and their susceptibility was 97.9% (47/48). The results of PCGS were closely correlated with those of U/A for pyuria and bacteriuria, and moderately correlated with the results of U/C for bacterial types. Two hundred and sixty-six patients were enrolled. The targeted therapy type and its susceptibility based on PCGS were analyzed, and each was investigated in two groups: the uncomplicated pyelonephritis group and the complicated pyelonephritis/prostatitis group. The usefulness of PCGS results were compared for urinalysis (U/A) and urine cultures (U/Cs). All enrolled patients were adults who had been admitted to the Division of Infectious Diseases with suspected fUTI. This hospital-based observational study was undertaken between January 2013 and March 2015 in Okinawa, Japan. The objective of this study was to clarify whether point-of-care Gram stain (PCGS) of urine contributed to fUTI diagnosis and treatment in adults. However, the treatment has become more complex because of the worldwide increase in antimicrobial resistance (AMR). Febrile urinary tract infections (fUTIs), which include pyelonephritis, prostatitis, and urosepsis, are the most common cause of sepsis.
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