Acute pyelonephritis in adults: prediction of mortality and failure of treatment

Arch Intern Med. 2003 May 26;163(10):1206-12. doi: 10.1001/archinte.163.10.1206.


Background: To formulate a classification tool for early recognition of patients admitted with acute pyelonephritis (AP) who are at high risk for failure of treatment or for death.

Methods: A retrospective chart review of 225 patients (102 men) admitted with AP. We considered 13 potential risk factors in a multivariate analysis.

Results: Recent hospitalization, previous use of antibiotics, and immunosuppression were found to be independent correlates of the prevalence of resistant pathogens in both sexes. Additional predictors included nephrolithiasis in women and a history of recurrent AP in men. Prolonged hospitalization should be expected for a man with diabetes and long-term catheterization who is older than 65 years or for a woman of any age with the same characteristics, when the initial treatment was changed according to the results of urine culture. For mortality prediction, we derived an integer-based scoring system with 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for previous antibiotic treatment for men and 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for immunosuppression for women. Among patients with at least 11 points, the risk for in-hospital death was 100% for men and 91% for women.

Conclusions: Simple variables available at presentation can be used for risk stratification of patients with AP. The additional identification of certain risk factors by means of a carefully obtained history could contribute to early recognition of patients infected by resistant bacteria and optimize the selection of antimicrobial agents.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Chi-Square Distribution
  • Drug Resistance, Microbial
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pyelonephritis / drug therapy*
  • Pyelonephritis / mortality*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Treatment Failure


  • Anti-Bacterial Agents