The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study
Background: The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cyst...
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| Format: | Article |
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MDPI AG
2022-11-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/12/1695 |
| _version_ | 1797461766083444736 |
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| author | Filip Jansåker Xinjun Li Ingvild Vik Niels Frimodt-Møller Jenny Dahl Knudsen Kristina Sundquist |
| author_facet | Filip Jansåker Xinjun Li Ingvild Vik Niels Frimodt-Møller Jenny Dahl Knudsen Kristina Sundquist |
| author_sort | Filip Jansåker |
| collection | DOAJ |
| description | Background: The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cystitis in women and explore if antibiotic treatment, cervical cancer, parity, and sociodemographic factors are related to these risks. Methods: This was a nationwide cohort study (2006–2018) of 752,289 women diagnosed with uncomplicated cystitis in primary healthcare settings. Of these, 404 696 did not redeem an antibiotic prescription within five days from cystitis. Logistic regression models were used to calculate odds ratios for pyelonephritis within 30 days and 90 days following the cystitis event. Results: Around one percent (7454) of all women with cystitis were diagnosed with pyelonephritis within 30 days, of which 78.2% had not redeemed an antibiotic for their cystitis. Antibiotic treatment was inversely associated with both outpatient registration and hospitalization due to pyelonephritis, with odds ratios of 0.85 (95% CI 0.80 to 0.91) and 0.65 (95% CI 0.55 to 0.77), respectively. Sociodemographic factors, parity, and cervical cancer were, with few exceptions (e.g., age and region of residency), not associated with pyelonephritis. Conclusions: Antibiotic treatment was inversely associated with pyelonephritis, but the absolute risk reduction was low. Non-antibiotic treatment for cystitis might be a safe option for most women. Future studies identifying the women at the highest risks will help clinicians in their decision making when treating cystitis, while keeping the ecological costs of antibiotics in mind. |
| first_indexed | 2024-03-09T17:23:59Z |
| format | Article |
| id | doaj.art-661156466c5c469cad52a5c12b312d80 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T17:23:59Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-661156466c5c469cad52a5c12b312d802023-11-24T12:52:48ZengMDPI AGAntibiotics2079-63822022-11-011112169510.3390/antibiotics11121695The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare StudyFilip Jansåker0Xinjun Li1Ingvild Vik2Niels Frimodt-Møller3Jenny Dahl Knudsen4Kristina Sundquist5Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, SwedenCenter for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, SwedenThe Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0318 Oslo, NorwayDepartment of Clinical Microbiology, Rigshospitalet, DK-2100 Copenhagen, DenmarkDepartment of Clinical Microbiology, Rigshospitalet, DK-2100 Copenhagen, DenmarkCenter for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, SwedenBackground: The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cystitis in women and explore if antibiotic treatment, cervical cancer, parity, and sociodemographic factors are related to these risks. Methods: This was a nationwide cohort study (2006–2018) of 752,289 women diagnosed with uncomplicated cystitis in primary healthcare settings. Of these, 404 696 did not redeem an antibiotic prescription within five days from cystitis. Logistic regression models were used to calculate odds ratios for pyelonephritis within 30 days and 90 days following the cystitis event. Results: Around one percent (7454) of all women with cystitis were diagnosed with pyelonephritis within 30 days, of which 78.2% had not redeemed an antibiotic for their cystitis. Antibiotic treatment was inversely associated with both outpatient registration and hospitalization due to pyelonephritis, with odds ratios of 0.85 (95% CI 0.80 to 0.91) and 0.65 (95% CI 0.55 to 0.77), respectively. Sociodemographic factors, parity, and cervical cancer were, with few exceptions (e.g., age and region of residency), not associated with pyelonephritis. Conclusions: Antibiotic treatment was inversely associated with pyelonephritis, but the absolute risk reduction was low. Non-antibiotic treatment for cystitis might be a safe option for most women. Future studies identifying the women at the highest risks will help clinicians in their decision making when treating cystitis, while keeping the ecological costs of antibiotics in mind.https://www.mdpi.com/2079-6382/11/12/1695antibioticscervical cancercomplicationscystitisparitypyelonephritis |
| spellingShingle | Filip Jansåker Xinjun Li Ingvild Vik Niels Frimodt-Møller Jenny Dahl Knudsen Kristina Sundquist The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study Antibiotics antibiotics cervical cancer complications cystitis parity pyelonephritis |
| title | The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study |
| title_full | The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study |
| title_fullStr | The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study |
| title_full_unstemmed | The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study |
| title_short | The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study |
| title_sort | risk of pyelonephritis following uncomplicated cystitis a nationwide primary healthcare study |
| topic | antibiotics cervical cancer complications cystitis parity pyelonephritis |
| url | https://www.mdpi.com/2079-6382/11/12/1695 |
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