Overuse of Diagnostic Testing in the Management of Korean Patients with Acute Pyelonephritis

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Acute pyelonephritis (APN) is an infection of the renal pelvis and kidney that usually results from a bacterial pathogen ascending the ureter from the bladder into the kidney [1]. It is one of the most common bacterial infections in the community setting. It is estimated that the annual incidence of APN is 35.7 per 10,000 people, with the APN hospitalization rate being 9.96 per 10,000 in women and 1.18 per 10 000 in men in South Korea [2]. The diagnosis of APN is primarily based on a combination of symptoms and evaluation of the urine for bacteria and white blood cells. The combination of fever, flank pain, frequency and dysuria is typical of APN in adults. Thus, history and physical examinations are the most useful tools for diagnosis. However, sometimes an additional work up is needed to manage APN. First, to identify the pathogen of APN, all patients with APN should have a urine culture with antimicrobial susceptibilities tested to confirm the appropriate choice of therapy [1]. The detection of the implicated pathogen in a urine culture facilitates a high diagnostic yield. Generally, blood cultures are considered to be an important tool for the evaluation and management of patients with bacterial infections. However, the diagnostic usefulness of blood cultures is controversial in patients with complicated and uncomplicated APN. Blood culture may only give information confirming whether bacte-remia exists or not and does not change the antibiotic therapy in most cases [3, 4]. Velasco et al. reported that the pathogens isolated from urine and from blood were different in only 2.3% of uncomplicated cases of APN. In addition, no changes to antibiotic therapy were required on the basis of blood culture results [4]. Nevertheless, blood cultures are still part of the routine work up for APN. For the purposes of this study, we are examining the current management of APN in the light of recent studies [5]. Kim et al. prospectively enrolled community acquired APN patients who visited 11 Korean hospitals over a period of 1 year. According to their study, blood culture analysis was performed in 78.3% (648/827) of APN patients and in 42.7% (277/648) of these patients bacteremia was detected. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients, and 15 of 645 patients (2.3%) changed the …