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Purpose <p>The microbial aetiologies of acute pyelonephritis (APN) may change over time. We aimed to describe long-term trends in microbiological diagnostics and pathogen distribution in patients with hospital-diagnosed APN, and to characterise clinical outcomes by pathogens.</p> Methods <p>We conducted a population-based, serial cross-sectional and cohort study of patients with hospital-diagnosed APN in North Denmark across three periods covering 2000-2018. National health registries were linked with microbiological data to describe temporal trends in microbiological diagnostics and pathogen distribution, and to provide a descriptive comparison of median length of stay (LOS) with interquartile range (IQR) and 30-day cumulative mortality with 95% confidence interval (CI) between <i>Escherichia coli</i> and non-<i>E. coli</i> APN.</p> Results <p>We identified 5338 APN episodes among 4773 patients. The proportion with urine culture increased from 75.1% in 2000-2006 to 92.9% in 2013-2018, with a concomitant increase in the proportion with a positive urine culture from 44.4% to 56.7%. The median LOS declined by 2&#xa0;days across calendar periods. <i>E. coli</i> remained the predominant pathogen with a prevalence in the range 77.3%-81.9%. Non-<i>E. coli</i> APN was more common in male, older, and comorbid patients, and was characterised by longer LOS (median 5&#xa0;days [IQR: 3-8] vs. 4&#xa0;days [IQR: 2-6]) and higher 30-day mortality (3.7% [95% CI 2.3%-5.2%] vs. 1.0% [95% CI 0.6%-1.5%]) compared with <i>E. coli</i>.</p> Conclusion <p>Microbiological testing increased during the study period, and the pathogen distribution remained largely stable with <i>E. coli</i> as the predominant uropathogen. Non-<i>E. coli</i> infections were associated with slightly less favourable short-term outcomes.</p>

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Uropathogens and prognosis among patients with hospital-diagnosed acute pyelonephritis: insights from a 19-year population-based cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月23日

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  • Lise Skovgaard Svingel,
  • Mette Nørgaard,
  • Christian Fynbo Christiansen,
  • Henrik Birn,
  • Hans Linde Nielsen,
  • Kirstine Kobberøe Søgaard

摘要

Purpose

The microbial aetiologies of acute pyelonephritis (APN) may change over time. We aimed to describe long-term trends in microbiological diagnostics and pathogen distribution in patients with hospital-diagnosed APN, and to characterise clinical outcomes by pathogens.

Methods

We conducted a population-based, serial cross-sectional and cohort study of patients with hospital-diagnosed APN in North Denmark across three periods covering 2000-2018. National health registries were linked with microbiological data to describe temporal trends in microbiological diagnostics and pathogen distribution, and to provide a descriptive comparison of median length of stay (LOS) with interquartile range (IQR) and 30-day cumulative mortality with 95% confidence interval (CI) between Escherichia coli and non-E. coli APN.

Results

We identified 5338 APN episodes among 4773 patients. The proportion with urine culture increased from 75.1% in 2000-2006 to 92.9% in 2013-2018, with a concomitant increase in the proportion with a positive urine culture from 44.4% to 56.7%. The median LOS declined by 2 days across calendar periods. E. coli remained the predominant pathogen with a prevalence in the range 77.3%-81.9%. Non-E. coli APN was more common in male, older, and comorbid patients, and was characterised by longer LOS (median 5 days [IQR: 3-8] vs. 4 days [IQR: 2-6]) and higher 30-day mortality (3.7% [95% CI 2.3%-5.2%] vs. 1.0% [95% CI 0.6%-1.5%]) compared with E. coli.

Conclusion

Microbiological testing increased during the study period, and the pathogen distribution remained largely stable with E. coli as the predominant uropathogen. Non-E. coli infections were associated with slightly less favourable short-term outcomes.