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Editor's Correspondence
October 27, 2003

Definition of Acute Pyelonephritis vs the Urosepsis Syndrome—Reply

Arch Intern Med. 2003;163(19):2393-2394. doi:10.1001/archinte.163.19.2393-a

In reply

We appreciate the wise comments of Dr Kunin on my and my colleagues' article on prediction of mortality and failure of treatment in adults with acute pyelonephritis.1 Dr Kunin suggests that a more appropriate title for our article would have been "The Urosepsis Syndrome in Adults With Complicated Urinary Tract Infections." We agree with Dr Kunin that proper nomenclature is important to allow proper comparisons to be made. One of the reasons we performed our study was the lack of data, especially in men, on the ability to predict mortality and failure of treatment due to resistant pathogens in patients with the most severe forms of urinary tract infections (UTIs). Indeed, as we state in the introduction of our study,1 numerous studies have focused on antimicrobial resistance of bacteria that cause UTIs in general, without attempts to differentiate the most severe from the most benign (namely, cystitis) forms of UTIs. We have chosen the term acute pyelonephritis to characterize the severe form of UTI because it is an established term in wide clinical use and most clinicians are familiar with it. Nevertheless, we are ready to accept that Dr Kunin's new term urosepsis syndrome would be more appropriate for the patients in our study. After all, the term is of Greek origin and accurate in terms of linguistics. On the other hand, since some of the patients in our study had no complicated UTI, the use of the term complicated UTI in the title of the article would be less appropriate.

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