Efstathiou et al1 describe the prognostic factors among a group of patients admitted to a hospital with the presumed diagnosis of acute pyelonephritis. Their criteria for pyelonephritis were significant bacteriuria and a concordant positive blood culture or the simultaneous presence of fever, pyuria, and significant bacteriuria. It is not possible to tell from the report whether the source of the infection was the kidney, bladder, or prostate. This is understandable given the costs of performing extensive studies that may not have been clinically indicated. Most of the patients had complicated urinary tract infections associated with bacteremia (60.0%), septic shock (22.2%), and urinary obstruction (23.1%). Almost half were men. Most of the women (73.9%) were older than 65 years. Many of the patients were bedridden, immunosuppressed, had long-term catheterization, and had multiple underlying risk factors including recent hospitalization, diabetes, nephrolithiasis, and prostatic hypertrophy.
Kunin CM. Definition of Acute Pyelonephritis vs the Urosepsis Syndrome. Arch Intern Med. 2003;163(19):2393. doi:10.1001/archinte.163.19.2393-a