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We aimed to describe long-term trends in microbiological diagnostics and pathogen distribution in patients with hospital-diagnosed APN, and to characterise clinical outcomes by pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a population-based, serial cross-sectional and cohort study of patients with hospital-diagnosed APN in North Denmark across three periods covering 2000-2018. National health registries were linked with microbiological data to describe temporal trends in microbiological diagnostics and pathogen distribution, and to provide a descriptive comparison of median length of stay (LOS) with interquartile range (IQR) and 30-day cumulative mortality with 95% confidence interval (CI) between\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      and non-\n                      <jats:italic>E. coli<\/jats:italic>\n                      APN.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 5338 APN episodes among 4773 patients. The proportion with urine culture increased from 75.1% in 2000-2006 to 92.9% in 2013-2018, with a concomitant increase in the proportion with a positive urine culture from 44.4% to 56.7%. The median LOS declined by 2\u00a0days across calendar periods.\n                      <jats:italic>E. coli<\/jats:italic>\n                      remained the predominant pathogen with a prevalence in the range 77.3%-81.9%. Non-\n                      <jats:italic>E. coli<\/jats:italic>\n                      APN was more common in male, older, and comorbid patients, and was characterised by longer LOS (median 5\u00a0days [IQR: 3-8] vs. 4\u00a0days [IQR: 2-6]) and higher 30-day mortality (3.7% [95% CI 2.3%-5.2%] vs. 1.0% [95% CI 0.6%-1.5%]) compared with\n                      <jats:italic>E. coli<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Microbiological testing increased during the study period, and the pathogen distribution remained largely stable with\n                      <jats:italic>E. coli<\/jats:italic>\n                      as the predominant uropathogen. Non-\n                      <jats:italic>E. coli<\/jats:italic>\n                      infections were associated with slightly less favourable short-term outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02729-7","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T17:45:35Z","timestamp":1769190335000},"page":"917-929","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uropathogens and prognosis among patients with hospital-diagnosed acute pyelonephritis: insights from a 19-year population-based cohort study"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4938-037X","authenticated-orcid":false,"given":"Lise Skovgaard","family":"Svingel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6110-5891","authenticated-orcid":false,"given":"Mette","family":"N\u00f8rgaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-953X","authenticated-orcid":false,"given":"Christian Fynbo","family":"Christiansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3715-7266","authenticated-orcid":false,"given":"Henrik","family":"Birn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2370-417X","authenticated-orcid":false,"given":"Hans Linde","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3624-7999","authenticated-orcid":false,"given":"Kirstine Kobber\u00f8e","family":"S\u00f8gaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"2729_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298931","volume":"19","author":"J Redondo-S\u00e1nchez","year":"2024","unstructured":"Redondo-S\u00e1nchez J, Rodr\u00edguez-Barrientos R, de-Hoyos-Alonso MDC, Munta\u00f1ola-Valero C, Almendro Mart\u00ednez I, Pe\u00f1alver-Arg\u00fceso B, et al. 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The Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to and administered by Aarhus University. None of these studies are related to the current study. L.S.S., C.F.C., K.K.S., and M.N. declare they have no personal financial interest. H.B. has received funding and honoraria from GlaxoSmithKline, Vifor Pharma, NOVO Foundation, Augustinus Foundation, NOVO Nordisk, Astra Zeneca, Bayer, Boehringer Ingelheim, Alexion, Netdoktor.dk, BestPractice Nordic, and Novartis. H.B. holds a patent on urinary biomarkers. Non-financial interests: H.B. has been on the advisory board of Astra Zeneca, Vifor Pharma, Boehringer Ingelheim, GlaxoSmithKline, and Galapagos IDMC. H.B. has served as chair of the Danish Society of Nephrology. H.B. has participated in a working group for the Danish Health Authority. M.N. serves as board member of the International Society for Pharmacoepidemiology.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was reported to the Danish Data Protection Agency through institutional registration (Aarhus University record number 2016\u2013051-000001\/812) and did not require approval from an ethics committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study was approved by the Central Denmark Region (journal number 1-45-70-5-21\/1-45-70-5-21) and did not require informed patient consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}