From the Guidelines
Yes, a patient can have pyelonephritis (kidney infection) without having cystitis (bladder infection). While most kidney infections develop when bacteria from a bladder infection travel up the ureters to the kidneys, kidney infections can occasionally occur through other routes, such as through the bloodstream from another infection site in the body, or rarely through direct trauma 1. People with structural abnormalities of the urinary tract, kidney stones, or weakened immune systems are at higher risk for developing kidney infections without preceding bladder infections.
Key Points to Consider
- Symptoms of a kidney infection typically include high fever, flank pain, nausea, vomiting, and sometimes blood in urine.
- Treatment usually involves antibiotics, with fluoroquinolones and cephalosporins being the only antimicrobial agents recommended for oral empiric treatment of uncomplicated pyelonephritis 1.
- The choice of antibiotic and duration of treatment should be based on local resistance patterns and optimized, with short-course therapy being recommended for uncomplicated pyelonephritis, either with fluoroquinolones (5 to 7 days) or trimethoprim-sulfamethoxazole (14 days) based on antibiotic susceptibility 1.
- Severe cases may require hospitalization for intravenous antibiotics, and it's essential to seek medical attention promptly for suspected kidney infections as they can lead to serious complications if left untreated.
Important Considerations for Treatment
- Urine culture and susceptibility testing should always be performed in patients suspected of having pyelonephritis, and initial empirical therapy should be tailored appropriately on the basis of the infecting uropathogen 1.
- Patients with underlying diabetes are of particular concern as they are more vulnerable to complications from acute pyelonephritis, including renal abscesses and emphysematous pyelonephritis 1.
From the Research
Pyelonephritis without Cystitis
- Pyelonephritis is a type of urinary tract infection that affects the kidneys, while cystitis is an infection of the bladder 2, 3.
- It is possible for a patient to have pyelonephritis without having cystitis, as the two infections can occur independently of each other 3, 4.
- The symptoms of pyelonephritis can include fever, chills, flank pain, and costovertebral angle tenderness, while cystitis is typically characterized by symptoms such as dysuria, frequency, and suprapubic pain 3, 5.
- A diagnosis of pyelonephritis can be made through a combination of clinical findings, urinalysis, and urine culture, and treatment typically involves antibiotics targeted towards the causative organism 3, 5.
Key Points
- Pyelonephritis and cystitis are two distinct types of urinary tract infections 2, 3.
- Pyelonephritis can occur without cystitis, and vice versa 3, 4.
- Accurate diagnosis and treatment of pyelonephritis are crucial to prevent complications and improve outcomes 3, 5.
- Antibiotic therapy should be guided by the results of urine culture and susceptibility testing, as well as local resistance patterns 5, 4.