{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:41:30Z","timestamp":1770756090591,"version":"3.50.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/01700"],"award-info":[{"award-number":["PI19\/01700"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the incidence of pyelonephritis in primary care in Spain from 2009 to 2018, assess the associated antibiotic prescriptions, and analyse trends by sex and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This is a retrospective observational population-based national study using the Database for Pharmacoepidemiological Research in the Public Domain (BIFAP), which contains primary care electronic medical records\n                      <jats:italic>,<\/jats:italic>\n                      and is representative of the Spanish population. Patients with a diagnosis of pyelonephritis were included. Sociodemographic and clinical data were collected. Crude and adjusted incidence rates were calculated per 10,000 person-years by sex and age, and annual and global percentages of antibiotic use were calculated by sex, age, and antibiotic group. Trend analysis was performed using a joinpoint regression model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>24,888 cases of pyelonephritis were recorded with an incidence of 4.2\/10,000 person-years (6.6 women vs 1.5 men). An annual decreasing trend was observed in women (AAPC average annual percentage change) \u20132.7 (95% CI \u22124.4;-0.9), men \u22123.0 (95% CI \u22124.5;-1.5), patients aged 18\u201364 years \u22122.9 (95% CI \u22124.7;-0.9) and \u2265 65 years \u22124.2 (95% CI \u22125.8;-2.4). The most frequently used groups of antibiotics were cephalosporins (38.7%), quinolones (30%), combined penicillins (22.2%) and fosfomycin (6.8%). Cephalosporin prescription predominated in women (39.8%), and quinolone prescription in men (40.3%). The most prescribed cephalosporins were third and second generation (21% and 17.7% respectively). A downward annual trend was observed in the global use of antibiotics AAPC \u22120.8 (95% CI \u22121.4; \u22120.2), with an increasing AAPC 1.7 (95% CI \u22120.6; 3.4) in \u226565 years. Among the groups of antibiotics, the prescription of quinolones AAPC \u22126.9 (95% CI \u221231.7;17.3) and penicillins AAPC \u22128.7 (95% CI \u221211.2;-6.8) decreased and cephalosporins increased AAPC 19.0 (95% CI 12.2;26).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Women had a fourfold higher incidence of acute pyelonephritis than men, with a decreasing trend over the study period. Cephalosporins were the most commonly prescribed antibiotics in women, while quinolones were more common in men. An increasing trend in cephalosporin use and a decreasing in quinolone use were observed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338447","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T18:40:01Z","timestamp":1766169601000},"page":"e0338447","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population-based epidemiological analysis of acute pyelonephritis and antibiotic prescription in Spain (2009\u20132018)"],"prefix":"10.1371","volume":"20","author":[{"given":"Jes\u00fas","family":"Redondo-S\u00e1nchez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0440-6588","authenticated-orcid":true,"given":"Ricardo","family":"Rodr\u00edguez-Barrientos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-2805","authenticated-orcid":true,"given":"Cristina","family":"Munta\u00f1ola-Valero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00aa del 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Holm","year":"2019","journal-title":"Scand J Prim Health Care"},{"key":"pone.0338447.ref026","volume-title":"Guidelines on urological infections","author":"European Association of Urology EAU","year":"2025"},{"key":"pone.0338447.ref027","article-title":"Pielonefritis aguda.","volume-title":"Gu\u00edas para el diagnostico y tratamiento de las enfermedades infecciosas","author":"J Molina Gil-Bermejo"},{"key":"pone.0338447.ref028","doi-asserted-by":"crossref","unstructured":"Trautner BW, Cortes-Penfield NW, Gupta K. Clinical practice guideline by Infectious Diseases Society of America (IDSA): 2025 guideline on management and treatment of complicated urinary tract infections: selection of antibiotic therapy for complicated UTI. https:\/\/www.idsociety.org\/globalassets\/idsa\/practice-guidelines\/cuti\/clinical-question-1.pdf. 2025.","DOI":"10.1093\/cid\/ciaf461"},{"key":"pone.0338447.ref029","unstructured":"Gu\u00eda terap\u00e9utica antimicrobiana del SNS. https:\/\/www.resistenciaantibioticos.es\/es\/guias\/humana\/login. Accessed 2023 October 1."},{"issue":"5","key":"pone.0338447.ref030","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.eimc.2016.11.005","article-title":"Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)","volume":"35","author":"M de Cueto","year":"2017","journal-title":"Enferm Infecc Microbiol Clin"},{"issue":"12","key":"pone.0338447.ref031","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1007\/s10096-018-3371-y","article-title":"A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis","volume":"37","author":"JWS Cattrall","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"pone.0338447.ref032","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3947\/ic.2018.50.1.67","article-title":"Clinical Practice Guidelines for the Antibiotic Treatment of 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