Epidemiology of severe purulent pyelonephritis: narrative review
DOI: 10.32364/2587-6821-2026-10-4-9
Epidemiology of severe purulent pyelonephritis: narrative review
V.N. Pavlov1, V.A. Vorobyov1,2, V.A. Ananiev1,3
1 Bashkir State Medical University, Ufa, Russian Federation
2 Irkutsk State Medical University, Irkutsk, Russian Federation
3 Territory Regional Clinical Hospital, Barnaul, Russian Federation
Severe purulent pyelonephritis (SPP) does not have a single international definition, and foreign authors is more often consider it as a part of severe phenotypes of acute pyelonephritis, complicated urinary tract infections, renal abscesses, emphysematous pyelonephritis and urosepsis.
Аim: to summarize current data on epidemiology of SPP and related severe phenotypes of complicated pyelonephritis; to identify key demographic and clinical features, risk factors, pathogenetic mechanisms, microbiological trends, outcomes, and directions for further studies.
The review analyzes clinical guidelines, population-based studies, systematic reviews, and meta-analyses. According to Global Burden of Disease studies, more than 404.6 million cases of urinary tract infections and related fatal outcomes were reported (236.8 thousand and 5.2 million years of healthy life lost adjusted for disability) in 2019; in 2021, standardized morbidity was 5531.88 per 100000. Population-based studies of acute pyelonephritis demonstrate marked heterogeneity: from 4.2 cases per 10000 person years (according to the Spanish Primary Care Network) to 39.1 cases per 10000 (Korea).
Given this epidemiological heterogeneity, identification of risk groups is of practical importance. Elderly age, pregnancy, diabetes mellitus, obesity, urinary tract obstruction, urolithiasis, catheterization, immunosuppression, and antibiotic-resistant pathogens are main risk factors for severe course. For example, emphysematous pyelonephritis is accompanied by high mortality, and catheterization is associated with a daily increase in bacteriuria by 3-8%. The review highlights a need for local SPP registries and adaptation of treatment algorithms to regional resistance data.
Keywords: severe purulent pyelonephritis, acute pyelonephritis, complicated urinary tract infections, urosepsis, kidney abscess, emphysematous pyelonephritis, antibiotic resistance.
For citation: Pavlov V.N., Vorobyov V.A., Ananiev V.A. Epidemiology of severe purulent pyelonephritis: narrative review. Russian Medical Inquiry. 2026;10(4):227–234 (in Russ.). DOI: 10.32364/2587-6821-2026-10-4-9
About the authors:
Valentin N. Pavlov — Academician of the Russian Academy of Sciences, Dr. Sc. (Med.), Professor, Rector of BashkirState Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; ORCID iD 0000-0003-2125-4897
Vladimir A. Vorobyov — Dr. Sc. (Med.), Assistant Professor of the Department of Urology and Oncology, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; Professor of the Department of Faculty Surgery and Urology, Irkutsk State Medical University; 1, Krasnogo Vosstaniya str., Irkutsk, 664003, Russian Federation; ORCID iD 0000-0003-3285-5559
Vladimir A. Ananiev — C. Sc. (Med.), Postdoctoral Student of the Department of Urology and Oncology, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; Head of the Department of Urology No. 2, Territory Regional Clinical Hospital; 1, Lyapidevsky str., Barnaul, 656045, Russian Federation; ORCID iD 0000-0002-1636-3151
Contact information: Vladimir A. Ananiev, e-mail: urologkkb@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 15.03.2025.
Revised 07.04.2025.
Accepted 30.04.2025.
2. Kranz J., Bartoletti R., Bruyère F. et al. European Association of Urology Guidelines on Urological Infections: summary of the 2024 guidelines. Eur Urol. 2024;86(1):27–41. DOI: 10.1016/j.eururo.2024.03.035
3. Bonkat G., Bartoletti R., Bruyère F. et al. EAU Guidelines on Urological Infections. Arnhem: European Association of Urology; 2025. (Electronic resource.) URL: https://uroweb.org/guidelines/urological-infections (access date: 27.05.2026).
4. Flores-Mireles A.L., Walker J.N., Caparon M., Hultgren S.J. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–284. DOI: 10.1038/nrmicro3432
5. Singer M., Deutschman C.S., Seymour C.W. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287
6. Evans L., Rhodes A., Alhazzani W. et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. DOI: 10.1007/s00134-021-06506-y
7. Baethge C., Goldbeck-Wood S., Mertens S. SANRA — a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. DOI: 10.1186/s41073-019-0064-8
8. Shea B.J., Reeves B.C., Wells G. et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. DOI: 10.1136/bmj.j4008
9. Guyatt G.H., Oxman A.D., Vist G.E. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. DOI: 10.1136/bmj.39489.470347.AD
10. He Y., Zhao J., Han C. et al. Epidemiological trends and predictions of urinary tract infections in the Global Burden of Disease Study 2021. Sci Rep. 2025;15:4702. DOI: 10.1038/s41598-025-89240-5
11. Yang X., Chen H., Zheng Y. et al. Disease burden and long-term trends of urinary tract infections: a worldwide report. Front Public Health. 2022;10:888205. DOI: 10.3389/fpubh.2022.888205
12. Zeng Z., Zhan J., Zhang K. et al. Global, regional, and national burden of urinary tract infections from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019. World J Urol. 2022;40(3):755–763. DOI: 10.1007/s00345-021-03913-0
13. Czaja C.A., Scholes D., Hooton T.M., Stamm W.E. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis. 2007;45(3):273–280. DOI: 10.1086/519268
14. Kim B., Myung R., Kim J. et al. Descriptive epidemiology of acute pyelonephritis in Korea, 2010–2014: population-based study. J Korean Med Sci. 2018;33(49):e310. DOI: 10.3346/jkms.2018.33.e310
15. Svingel L.S., Christiansen C.F, Birn H. et al. Temporal changes in incidence of hospital-diagnosed acute pyelonephritis: a 19-year population-based Danish cohort study. IJID Reg. 2023;9:104–110. DOI: 10.1016/j.ijregi.2023.10.003
16. Redondo-Sánchez J., Rodríguez-Barrientos R., Muntañola-Valero C. et al. Population-based epidemiological analysis of acute pyelonephritis and antibiotic prescription in Spain (2009–2018). PLoS One. 2025;20(12):e0338447. DOI: 10.1371/journal.pone.0338447
17. Tandogdu Z., Wagenlehner F.M.E. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29(1):73–79. DOI: 10.1097/QCO.0000000000000228
18. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653–660. DOI: 10.1038/nrurol.2010.190
19. Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1–13. DOI: 10.1016/j.idc.2013.09.003
20. Scholes D., Hooton T.M., Roberts P.L. et al. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med. 2005;142(1):20–27. DOI: 10.7326/0003-4819-142-1-200501040-00008
21. Nicolle L.E. Urinary tract infections in the older adult. Clin Geriatr Med. 2016;32(3):523–538. DOI: 10.1016/j.cger.2016.03.003
22. Nicolle L.E. Urinary tract infections in special populations: diabetes, renal transplant, HIV infection, and spinal cord injury. Infect Dis Clin North Am. 2014;28(1):91–104. DOI: 10.1016/j.idc.2013.09.006
23. Siegel J.F., Smith A., Moldwin R. Minimally invasive treatment of renal abscess. J Urol. 1996;155(1):52–55.
24. Lee S.H., Jung H.J., Mah S.Y., Chung B.H. Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage. Yonsei Med J. 2010;51(4):569–573. DOI: 10.3349/ymj.2010.51.4.569
25. Wu S.Y., Yang S.S., Chang S.J., Hsu C.K. Emphysematous pyelonephritis: classification, management, and prognosis. Tzu Chi Med J. 2022;34(3):297–302. DOI: 10.4103/tcmj.tcmj_257_21
26. Ngo X.T., Nguyen T.T., Dobbs R.W. et al. Prevalence and risk factors of mortality in emphysematous pyelonephritis patients: a meta-analysis. World J Surg. 2022;46(10):2377–2388. DOI: 10.1007/s00268-022-06647-1
27. Huang J.J., Tseng C.C. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160(6):797–805. DOI: 10.1001/archinte.160.6.797
28. Falagas M.E., Alexiou V.G., Giannopoulou K.P., Siempos I.I. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007;178(3 Pt 1):880–885. DOI: 10.1016/j.juro.2007.05.017
29. Brown P., Ki M., Foxman B. Acute pyelonephritis among adults: cost of illness and considerations for the economic evaluation of therapy. Pharmacoeconomics. 2005;23(11):1123–1142. DOI: 10.2165/00019053-200523110-00005
30. Broughton E., Colosia A., Bektas M. et al. Assessing the economic burden of complicated urinary tract infection: a systematic literature review. Eur J Health Econ. 2025. DOI: 10.1007/s10198-025-01846-8. Epub ahead of print.
31. Graseck A.S., Thompson J.L., Bryant A.S. American College of Obstetricians and Gynecologists. Urinary tract infections in pregnant individuals. ACOG Clinical Consensus No. 4. Obstet Gynecol. 2023;142(2):435–445. DOI: 10.1097/AOG.0000000000005269
32. De Lemos Zanatta D.A., Rossini M.M., Trapani Júnior A. Pyelonephritis in pregnancy: clinical and laboratorial aspects and perinatal results. Rev Bras Ginecol Obstet. 2017;39(12):653–658. DOI: 10.1055/s-0037-1608627
33. Salari N., Karami M.M., Bokaee S. et al. The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis. Eur J Med Res. 2022;27:20. DOI: 10.1186/s40001-022-00644-9
34. Semins M.J., Shore A.D., Makary M.A. et al. The impact of obesity on urinary tract infection risk. Urology. 2012;79(2):266–269. DOI: 10.1016/j.urology.2011.09.040
35. Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2002;113 Suppl 1A:14S–19S. DOI: 10.1016/S0002-9343(02)01058-0
36. Kim B., Kim J.H., Lee Y. Virulence factors associated with Escherichia coli bacteremia and urinary tract infection. Ann Lab Med. 2022;42(2):203–212. DOI: 10.3343/alm.2022.42.2.203
37. Kakinoki H., Tobu S., Kakinoki Y. et al. Risk factors for uroseptic shock in patients with urolithiasis-related acute pyelonephritis. Urol Int. 2018;100(1):37–42. DOI: 10.1159/000481801
38. Hsiao C.Y., Yang H.Y., Hsiao M.C. et al. Urolithiasis is a risk factor for uroseptic shock and acute kidney injury in patients with urinary tract infection. Front Med (Lausanne). 2019;6:288. DOI: 10.3389/fmed.2019.00288
39. Hooton T.M., Bradley S.F., Cardenas D.D. et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–663. DOI: 10.1086/650482
40. Werneburg G.T. Catheter-associated urinary tract infections: current challenges and future prospects. Res Rep Urol. 2022;14:109–133. DOI: 10.2147/RRU.S273663
41. Livermore D.M. Current epidemiology and growing resistance of Gram-negative pathogens. Korean J Intern Med. 2012;27(2):128–142. DOI: 10.3904/kjim.2012.27.2.128
42. Pitout J.D.D., Laupland K.B. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8(3):159–166. DOI: 10.1016/S1473-3099(08)70038-5
43. Rodríguez-Baño J., Gutiérrez-Gutiérrez B., Machuca I., Pascual A. Treatment of infections caused by extended-spectrum-beta-lactamase-, AmpC-, and carbapenemase-producing Enterobacteriaceae. Clin Microbiol Rev. 2018;31(2):e00079-17. DOI: 10.1128/CMR.00079-17
44. Karanika S., Karantanos T., Arvanitis M. et al. Fecal colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae and risk factors among healthy individuals: a systematic review and meta-analysis. Clin Infect Dis. 2016;63(3):310–318. DOI: 10.1093/cid/ciw283
45. Ruiz-Lievano A.P., Salazar M., Falconi F. et al. Fluoroquinolone resistance in Escherichia coli causing community-acquired urinary tract infections: a systematic review. Microorganisms. 2024;12(11):2320. DOI: 10.3390/microorganisms12112320
46. Von Vietinghoff S., Shevchuk O., Dobrindt U. et al. The global burden of antimicrobial resistance — urinary tract infections. Nephrol Dial Transplant. 2024;39(4):581–588. DOI: 10.1093/ndt/gfad233
47. Efstathiou S.P., Pefanis A.V., Tsioulos D.I. et al. Acute pyelonephritis in adults: prediction of mortality and failure of treatment. Arch Intern Med. 2003;163(10):1206–1212. DOI: 10.1001/archinte.163.10.1206
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