Ledochowski Stanislas, Abraham Paul-Samuel, Jacob Xavier, Dumitrescu Oana, Lina Gérard, Lepape Alain, Piriou Vincent, Wallet Florent, Friggeri Arnaud
Service d'Anesthésie-Réanimation Médicale et Chirurgicale, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69395, Lyon, Pierre-Bénite, France.
Intern Emerg Med. 2015 Aug;10(5):607-12. doi: 10.1007/s11739-015-1223-7. Epub 2015 Mar 26.
Pyelonephritides are frequently encountered diagnosis in Emergency Departments. Urinalyses have a central place in the management of this situation but the usefulness of blood cultures is not clear. We conducted a single-center retrospective study of 24 months to study the microbiological relevance of blood cultures in pyelonephritis. We included patients with blood cultures (BC) and urine cultures (UC) drawn at the same time, if they were not exposed to antibiotics prior to these tests. Of our 264 patients, 39 (15 %) had no bacteriological documentation. There were 83 (31 %) bacteremic patients. Seven patients had contaminated or sterile UC with positive BC. Four patients had positive UC and BC with the latter allowing identification of a pathogen absent from the UC (n = 1) or identifying the main pathogen in three cases. A total of 11 patients theoretically benefited from BC representing 4.2 % of our population. Excluding one patient who was known to be infected with multi-drug resistant bacteria, all empirical antibiotics regimens were effective against the identified pathogens. We did not reveal any significant therapeutic impact of blood cultures in the management of pyelonephritis, when BC and UC are performed before any antimicrobials treatment.
肾盂肾炎是急诊科常见的诊断疾病。尿液分析在这种情况的处理中占据核心地位，但血培养的作用尚不清楚。我们进行了一项为期24个月的单中心回顾性研究，以探讨血培养在肾盂肾炎中的微生物学相关性。我们纳入了在未接受抗生素治疗前同时进行血培养（BC）和尿培养（UC）的患者。在我们的264例患者中，39例（15%）没有细菌学记录。有83例（31%）患者发生菌血症。7例患者尿培养污染或无菌，但血培养阳性。4例患者尿培养和血培养均阳性，其中血培养使得1例患者鉴定出尿培养中未发现的病原体，3例患者鉴定出主要病原体。理论上共有11例患者从血培养中获益，占我们研究人群的4.2%。排除1例已知感染多重耐药菌的患者，所有经验性抗生素治疗方案对鉴定出的病原体均有效。当在任何抗菌治疗前进行血培养和尿培养时，我们未发现血培养在肾盂肾炎治疗中有任何显著的治疗影响。
