From the Guidelines
Cystitis with fever is often indicative of pyelonephritis, and prompt treatment is necessary to prevent complications. When a urinary tract infection (UTI) that begins in the bladder (cystitis) is accompanied by fever, it typically suggests that the infection has ascended to the kidneys, becoming pyelonephritis 1. This is a more serious condition requiring prompt treatment. According to the European Association of Urology guidelines, fluoroquinolones and cephalosporins are the only antimicrobial agents that can be recommended for oral empiric treatment of uncomplicated pyelonephritis 1.
Some key points to consider in the treatment of pyelonephritis include:
- Urinalysis, including assessment of white and red blood cells and nitrite, is recommended for routine diagnosis 1
- A urine culture and antimicrobial susceptibility testing should be performed in all cases of pyelonephritis 1
- Evaluation of the upper urinary tract via ultrasound should be performed to rule out urinary tract obstruction or renal stone disease in patients with a history of urolithiasis, renal function disturbances or a high urine pH 1
- Patients with uncomplicated pyelonephritis requiring hospitalisation should be treated initially with an intravenous antimicrobial regimen, such as a fluoroquinolone, an aminoglycoside (with or without ampicillin), or an extended-spectrum cephalosporin or penicillin 1
The choice of antibiotic should be based on local resistance patterns and optimized. Patients should increase fluid intake, take pain relievers like acetaminophen for fever and discomfort, and complete the entire antibiotic course even if symptoms improve. The fever occurs because kidney infections trigger a systemic inflammatory response as the body fights the infection. Other symptoms that may accompany pyelonephritis include flank pain, nausea, vomiting, and chills, in addition to the typical UTI symptoms of frequent, painful urination. Anyone experiencing these symptoms should seek medical attention promptly to prevent complications like kidney damage or sepsis.
From the Research
Cystitis with Fever and Pyelonephritis
- Cystitis is a type of urinary tract infection (UTI) that affects the bladder, while pyelonephritis is an infection of the kidney [ 2 ].
- A fever can be a symptom of both cystitis and pyelonephritis, but it is more commonly associated with pyelonephritis [ 3 ].
- The presence of a fever in a patient with cystitis may indicate a more severe infection or the possibility of pyelonephritis [ 4 ].
Diagnosis and Treatment
- Urine culture is recommended for the diagnosis and management of pyelonephritis, recurrent UTIs, and complicated UTIs [ 2 ].
- Antibiotics are the primary treatment for both cystitis and pyelonephritis, with the choice of antibiotic depending on the severity of the infection and the patient's medical history [ 4 ].
- The duration of antibiotic treatment varies from 3 to 5 days for uncomplicated cystitis to 7 to 14 days for pyelonephritis [ 2 ].
Risk of Pyelonephritis following Cystitis
- The risk of pyelonephritis following uncomplicated cystitis in women is relatively low, with approximately 1% of women developing pyelonephritis within 30 days [ 5 ].
- Antibiotic treatment for cystitis is inversely associated with the risk of pyelonephritis, but the absolute risk reduction is low [ 5 ].
- Sociodemographic factors, parity, and cervical cancer are not significantly associated with the risk of pyelonephritis following cystitis [ 5 ].