Patients with febrile UTI generally present with mild illness in primary care but may rapidly HTC develop a life-threatening condition, progressing into septic shock and multiple organ failure. The overall mortality rate of pyelonephritis is approximately 0.3%, but in bacteremic patients it can be as high as 7.5% to 30% [3,4]. In addition, bacteremia in UTI is associated with prolonged hospitalization and higher complication rates [5-7]. Given this spectrum of disease, clinicians are vigilant to identify bacteremia at a patient’s presentation.The incidence of bacteremia in patients with acute pyelonephritis has been reported to be roughly 20% [8-10]. Several studies have been conducted to identify predictive characteristics of bacteremia in patients with UTI [6,7,11,12].

However, no single clinical model has been used in practice because of its poor value in predicting bacteremia. The gold standard for detection of bacteremia remains the performance of at least two blood cultures to achieve sufficient sensitivity [13]. There are, however, practical limitations. First of all, it takes at least 24 to 48 hours to attain the culture result. Secondly, there may be a false positive result as contamination rates of up to 7% have been reported [14]. Furthermore, the implementation of the surviving sepsis campaign, which recommends the immediate initiation of broad-spectrum antibiotic therapy once septicemia is suspected, leads to an increase in the performance of blood cultures with lower yield, likely reflecting the obtainment of additional cultures after initiation of antibiotics [15,16].

Therefore, there is a need for strategies that guide clinicians and help reduce avoidable blood cultures and, by consequence, medical costs.The biomarker procalcitonin (PCT) is a marker of systemic inflammation and thus it may help to predict bacteremia [17,18]. The aim of this study was to assess clinical characteristics and the PCT Dacomitinib value to predict bacteremia in patients with febrile UTI.Materials and methodsStudy design and settingWe conducted a prospective observational multicenter cohort study. Eight emergency departments (ED) of 7 hospitals and 35 affiliating primary health care centers, serving one single area of the Netherlands, participated. Consecutive patients who presented with a diagnosis of febrile UTI, were considered for enrollment in the study. Recruitment took place from January 2004 through November 2008 but each centre started at different time points. The study was approved by the local ethics committees and all included patients gave written informed consent.Inclusion and exclusion criteriaInclusion criteria were: age of 18 years or above, fever (defined as an tympanic temperature ��38.