Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Pyelonephritis | Research

Effect of anticoagulant and platelet inhibition on the risk of bacteremia among patients with acute pyelonephritis: a retrospective cohort study

Authors: Svava E. Steiner, Gustaf Edgren, Keira Melican, Agneta Richter-Dahlfors, Annelie Brauner

Published in: BMC Infectious Diseases | Issue 1/2022

Login to get access

Abstract

Background

An increasing number of patients are being prescribed anticoagulants and platelet inhibitors (antithrombotic treatment). Basic research has suggested an association between antithrombotic treatment and bacteremia during kidney infection. Here, we investigated the association between antithrombotic treatment, bacteremia and acute kidney injury in patients with acute pyelonephritis.

Methods

A retrospective cohort study was conducted in a large university hospital in Sweden. Data were retrieved from electronic medical records for adult patients with acute pyelonephritis in 2016. The main outcome was bacteremia and secondary outcome acute kidney injury. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated through multiple logistic regression. Treatment with different groups of antithrombotic agents were compared to no antithrombotic treatment.

Results

1814 patients with acute pyelonephritis were included, in whom bacteremia developed in 336 (18.5%). Low-molecular-weight heparin (LMWH) at prophylactic doses was associated with a lower risk of bacteremia, compared to no antithrombotic treatment (OR 0.5; 95% CI 0.3–0.7). Other antithrombotic treatments were not associated with a risk of bacteremia. Additionally, patients with prophylactic doses of LMWH had a lower risk of acute kidney injury (OR 0.5; 95% CI 0.3–0.8).

Conclusions

We found no association between antithrombotic treatment and an increased risk of bacteremia during acute pyelonephritis. Conversely, patients with prophylactic doses of LMWH had a slightly reduced risk of bacteremia. LMWH at prophylactic doses was also associated with a lower risk of acute kidney injury. Our results suggest that it is safe to continue antithrombotic treatment during acute pyelonephritis, in regards to bacteremia and acute kidney injury risk.
Appendix
Available only for authorised users
Literature
1.
Nakamura N, Uehara Y, Fukui S, Fujibayashi K, Yokokawa H, Naito T. Useful predictive factors for bacteremia among outpatients with pyelonephritis. Intern Med. 2018;57(10):1399–403.PubMedPubMedCentralCrossRef
2.
Wang C, Li Q, Lv J, Sun X, Cao Y, Yu K, Miao C, Zhang ZS, Yao Z, Wang Q. Alpha-hemolysin of uropathogenic Escherichia coli induces GM-CSF-mediated acute kidney injury. Mucosal Immunol. 2019;13(1):22–33.PubMedPubMedCentralCrossRef
3.
Hsu CY, Fang HC, Chou KJ, Chen CL, Lee PT, Chung HM. The clinical impact of bacteremia in complicated acute pyelonephritis. Am J Med Sci. 2006;332(4):175–80.PubMedCrossRef
4.
5.
van der Poll T, Herwald H. The coagulation system and its function in early immune defense. Thromb Haemost. 2014;112(4):640–8.PubMedCrossRef
6.
Claushuis TA, van Vught LA, Scicluna BP, Wiewel MA, Klein Klouwenberg PM, Hoogendijk AJ, Ong DS, Cremer OL, Horn J, Franitza M, et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood. 2016;127(24):3062–72.PubMedCrossRef
7.
Wang C, Chi C, Guo L, Wang X, Sun J, Sun B, Liu S, Chang X, Li E. Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis. Crit Care. 2014;18(5):563.PubMedPubMedCentralCrossRef
8.
Zarychanski R, Abou-Setta AM, Kanji S, Turgeon AF, Kumar A, Houston DS, Rimmer E, Houston BL, McIntyre L, Fox-Robichaud AE, et al. The efficacy and safety of heparin in patients with sepsis: a systematic review and metaanalysis. Crit Care Med. 2015;43(3):511–8.PubMedCrossRef
9.
Murao S, Yamakawa K. A systematic summary of systematic reviews on anticoagulant therapy in sepsis. J Clin Med. 2019;8(11):1869.PubMedCentralCrossRef
10.
Schouten M, Van’t Veer C, Poulussen N, Meijers JC, Levi M, Esmon CT, van der Poll T. The cytoprotective effects of endogenous activated protein C reduce activation of coagulation during murine pneumococcal pneumonia and sepsis. Thromb Res. 2015;135(3):537–43.PubMedCrossRef
11.
Levi M, Vincent JL, Tanaka K, Radford AH, Kayanoki T, Fineberg DA, Hoppensteadt D, Fareed J. Effect of a recombinant human soluble thrombomodulin on baseline coagulation biomarker levels and mortality outcome in patients with sepsis-associated coagulopathy. Crit Care Med. 2020;48(8):1140–7.PubMedPubMedCentralCrossRef
12.
Vincent JL, Francois B, Zabolotskikh I, Daga MK, Lascarrou JB, Kirov MY, Pettilä V, Wittebole X, Meziani F, Mercier E, et al. Effect of a recombinant human soluble thrombomodulin on mortality in patients with sepsis-associated coagulopathy: the SCARLET randomized clinical trial. JAMA. 2019;321(20):1993–2002.PubMedPubMedCentralCrossRef
13.
Ruiz-Rosado JD, Robledo-Avila F, Cortado H, Rangel-Moreno J, Justice SS, Yang C, Spencer JD, Becknell B, Partida-Sanchez S. Neutrophil-macrophage imbalance drives the development of renal scarring during experimental pyelonephritis. J Am Soc Nephrol. 2021;32(1):69–85.PubMedCrossRef
14.
Melican K, Boekel J, Månsson LE, Sandoval RM, Tanner GA, Källskog O, Palm F, Molitoris BA, Richter-Dahlfors A. Bacterial infection-mediated mucosal signalling induces local renal ischaemia as a defence against sepsis. Cell Microbiol. 2008;10(10):1987–98.PubMedCrossRef
15.
Schulz A, Chuquimia OD, Antypas H, Steiner SE, Sandoval RM, Tanner GA, Molitoris BA, Richter-Dahlfors A, Melican K. Protective vascular coagulation in response to bacterial infection of the kidney is regulated by bacterial lipid A and host CD147. Pathog Dis. 2018;76(8):fty087.PubMedCentralCrossRef
16.
Sedin J, Giraud A, Steiner SE, Ahl D, Persson AEG, Melican K, Richter-Dahlfors A, Phillipson M. High resolution intravital imaging of the renal immune response to injury and infection in mice. Front Immunol. 2019;10:2744.PubMedPubMedCentralCrossRef
17.
Kaack MB, Dowling KJ, Patterson GM, Roberts JA. Immunology of pyelonephritis. VIII. E. coli causes granulocytic aggregation and renal ischemia. J Urol. 1986;136(5):1117–22.PubMedCrossRef
18.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962.PubMedCrossRef
19.
20.
Yildiz H, Van Nieuwenhove S, Doyen M, Yombi JC. Acute pyelonephritis and renal vein thrombosis: a case report and review of the literature. J Infect Chemother. 2016;22(11):759–61.PubMedCrossRef
21.
Bassilios N, Tassart M, Restoux A, Bigot JM, Rondeau E, Sraer JD. Inferior vena cava thrombosis due to acute pyelonephritis. Nephrol Dial Transpl. 2004;19(4):981–3.CrossRef
22.
Novelli L, Raynaud A, Pellerin O, Carreres T, Sapoval M. Percutaneous manual aspiration embolectomy of renal vein thrombosis due to acute pyelonephritis. Cardiovasc Intervent Radiol. 2007;30(5):1075–8.PubMedCrossRef
23.
Butt JH, Fosbøl EL, Verhamme P, Gerds TA, Iversen K, Bundgaard H, Bruun NE, Larsen AR, Petersen A, Andersen PS, et al. Dabigatran and the risk of Staphylococcus aureus bacteremia—a nationwide cohort study. Clin Infect Dis. 2020;73(3):480–6.CrossRef
24.
Durkin MJ, Dukes JL, Reeds DN, Mazuski JE, Camins BC. A descriptive study of the risk factors associated with catheter-related bloodstream infections in the home parenteral nutrition population. JPEN J Parenter Enteral Nutr. 2016;40(7):1006–13.PubMedCrossRef
25.
Slofstra SH, van’t Veer C, Buurman WA, Reitsma PH, ten Cate H, Spek CA. Low molecular weight heparin attenuates multiple organ failure in a murine model of disseminated intravascular coagulation. Crit Care Med. 2005;33(6):1365–70.PubMedCrossRef
26.
Fisher J, Russell JA, Bentzer P, Parsons D, Secchia S, Mörgelin M, Walley KR, Boyd JH, Linder A. Heparin-binding protein (HBP): a causative marker and potential target for heparin treatment of human sepsis-induced acute kidney injury. Shock. 2017;48(3):313–20.PubMedCrossRef
27.
Tydén J, Herwald H, Hultin M, Walldén J, Johansson J. Heparin-binding protein as a biomarker of acute kidney injury in critical illness. Acta Anaesthesiol Scand. 2017;61(7):797–803.PubMedCrossRef
28.
Semeraro F, Ammollo CT, Morrissey JH, Dale GL, Friese P, Esmon NL, Esmon CT. Extracellular histones promote thrombin generation through platelet-dependent mechanisms: involvement of platelet TLR2 and TLR4. Blood. 2011;118(7):1952–61.PubMedPubMedCentralCrossRef
29.
Davis RP, Miller-Dorey S, Jenne CN. Platelets and coagulation in infection. Clin Transl Immunol. 2016;5(7): e89.CrossRef
30.
Linder A, Soehnlein O, Akesson P. Roles of heparin-binding protein in bacterial infections. J Innate Immun. 2010;2(5):431–8.PubMedCrossRef
31.
32.
Xu J, Zhang X, Pelayo R, Monestier M, Ammollo CT, Semeraro F, Taylor FB, Esmon NL, Lupu F, Esmon CT. Extracellular histones are major mediators of death in sepsis. Nat Med. 2009;15(11):1318–21.PubMedPubMedCentralCrossRef
33.
Sahu A, Pangburn MK. Identification of multiple sites of interaction between heparin and the complement system. Mol Immunol. 1993;30(7):679–84.PubMedCrossRef
34.
Yu H, Muñoz EM, Edens RE, Linhardt RJ. Kinetic studies on the interactions of heparin and complement proteins using surface plasmon resonance. Biochim Biophys Acta. 2005;1726(2):168–76.PubMedPubMedCentralCrossRef
35.
Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG. Acute pyelonephritis: clinical characteristics and the role of the surgical treatment. J Korean Med Sci. 2009;24(2):296–301.PubMedPubMedCentralCrossRef
36.
Bahagon Y, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis. 2007;26(5):349–52.PubMedCrossRef
37.
Kim KS, Kim K, Jo YH, Kim TY, Lee JH, Lee SJ, Rhee JE, Suh GJ. A simple model to predict bacteremia in women with acute pyelonephritis. J Infect. 2011;63(2):124–30.PubMedCrossRef
Metadata
Title
Effect of anticoagulant and platelet inhibition on the risk of bacteremia among patients with acute pyelonephritis: a retrospective cohort study
Authors
Svava E. Steiner
Gustaf Edgren
Keira Melican
Agneta Richter-Dahlfors
Annelie Brauner
Publication date
01-12-2022

Other articles of this Issue 1/2022

BMC Infectious Diseases 1/2022 Go to the issue

Study protocol

Analysing the protection from respiratory tract infections and allergic diseases early in life by human milk components: the PRIMA birth cohort

Research

Tuberculosis burden caused by migrant population in Eastern China: evidence from notification records in Zhejiang Province during 2013–2017

Research

First trend analysis of antifungals consumption in Lebanon using the World Health Organization collaborating center for drug statistics methodology

Research

The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study

Research

Clinical outcomes of dengue virus infection in pregnant and non-pregnant women of reproductive age: a retrospective cohort study from 2016 to 2019 in Paraná, Brazil

Research article

Surveillance of SARS-CoV-2 antibodies of patients in the local affected area during Wuhan lockdown

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits