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Internal Medicine (Tokyo, Japan) Jul 2024Obstructive tract infection caused by urease-producing bacteria can lead to hyperammonemia. We herein report a 73-year-old woman with diabetes and compensated liver...
Obstructive tract infection caused by urease-producing bacteria can lead to hyperammonemia. We herein report a 73-year-old woman with diabetes and compensated liver cirrhosis who developed obstructive pyelonephritis. Her consciousness level declined on day 3 of hospitalization. Blood tests revealed an elevated ammonia level of 140 μg/dL. Urine and blood cultures identified Proteus mirabilis as a urease-producing bacterium. The treatment included double J (WJ) catheter insertion and administration of antimicrobial agents. On day 7 of hospitalization, the ammonia level gradually decreased, and the patient's consciousness improved. However, despite these interventions, perinephric overflow of urine persisted, necessitating nephrectomy.
Topics: Humans; Hyperammonemia; Aged; Female; Proteus mirabilis; Urease; Urinary Tract Infections; Pyelonephritis; Proteus Infections; Anti-Bacterial Agents; Diabetes Complications
PubMed: 37926530
DOI: 10.2169/internalmedicine.2817-23 -
Medicina (Kaunas, Lithuania) Sep 2023Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients... (Review)
Review
Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients are more likely to develop infections, including many common infections, but also pathognomonic ones such as emphysematous pyelonephritis, malignant otitis externa, mucormycosis and Fournier's gangrene. Considering the fact that diabetic patients experience more frequently urinary tract infections (UTIs) with a worse prognosis than non-diabetic people, we conducted a review study based on data in the literature, following the particularities of UTIs in this group of patients, the risk factors, the mechanisms involved and the challenges in their management. The findings highlight that UTI in diabetic patients have some particularities, including a more frequent evolution to bacteremia, increased hospitalizations, and elevated rates of recurrence and mortality than non-diabetic patients. The possible risk factors identified seem to be female gender, pregnancy, older age, UTI in the previous six months, poor glycemic control and duration of diabetes. The mechanisms involved are related to glucosuria and bladder dysfunction, factors related to bacterial strains and host response. The bacterial strains involved in UTIs in diabetic patients and their antibiotic susceptibility profile are, with some exceptions, similar to those in non-diabetic people; however, the antimicrobial agents should be carefully chosen and the duration of the treatment should be as those required for a complicated UTI. The data related to the risk of developing UTIs in patients treated with SGLT-2 inhibitors, a new class of oral hypoglycaemic agents with cardiovascular and renal benefits, are controversial; overall, it was evidenced that UTIs occurred at the initiation of the treatment, recurrent infection was uncommon and the majority of UTIs responded to treatment with standard antibiotics. Moreover, interruption or discontinuation of SGLT-2 inhibitor as a result of UTI was rare and SGLT-2 inhibitors did not increase the risk of severe infections such as urosepsis and pyelonephritis.
Topics: Pregnancy; Humans; Female; Sodium-Glucose Transporter 2 Inhibitors; Urinary Tract Infections; Diabetes Mellitus; Pyelonephritis; Anti-Bacterial Agents
PubMed: 37893465
DOI: 10.3390/medicina59101747 -
[Research on mechanisms of drug resistance and virulence expression in pathogenic Escherichia coli].Nihon Saikingaku Zasshi. Japanese... 2023Urinary tract infections (UTIs) are one of the most common infections. Uropathogenic Escherichia coli (UPEC) is the most common causative organism. Once UPEC enters the...
Urinary tract infections (UTIs) are one of the most common infections. Uropathogenic Escherichia coli (UPEC) is the most common causative organism. Once UPEC enters the urinary tract, it infects the bladder and then ascends the urinary tract to the kidneys, where it causes pyelonephritis, a more severe form of the disease. While various virulence factors, including adhesions and cytotoxic factors to bladder epithelial cells, have been identified and their functions have been analyzed, the question remains, "How can UPEC, which is harmless in the intestinal tract, be induced to become pathogenic in the urinary tract?" and "How does UPEC ascend the urinary tract and infect the kidneys?" On the other hand, UPEC invades host cells and forms biofilm-like microcolonies that are resistant to various antimicrobial agents. We are working to solve this problem by identifying the factors responsible for the virulence of UPEC and the establishment of infection of the kidney, as well as the factors involved in microcolony formation and elucidating their functions. Here I outline the virulence expression of UPEC from bladder to kidney infection and the mechanism of UTI refractoriness, focusing on our studies.
Topics: Humans; Escherichia coli; Virulence; Escherichia coli Infections; Urinary Tract Infections; Pyelonephritis; Virulence Factors; Escherichia coli Proteins; Drug Resistance
PubMed: 37880099
DOI: 10.3412/jsb.78.167 -
Clinical and Translational Science Dec 2023The efficacy of converting to oral fluoroquinolones after initial intravenous antibiotics for the treatment of acute pyelonephritis (APN) caused by the third-generation... (Randomized Controlled Trial)
Randomized Controlled Trial
A randomized, controlled trial of prulifloxacin as conversion therapy after intravenous carbapenem in the treatment of acute pyelonephritis caused by third generation cephalosporin resistant pathogens: A pilot study.
The efficacy of converting to oral fluoroquinolones after initial intravenous antibiotics for the treatment of acute pyelonephritis (APN) caused by the third-generation cephalosporin resistant Enterobacteriaceae (3-GCrEC) needs to be investigated. The objective was to compare the clinical and bacteriological outcome of oral prulifloxacin with intravenous ertapenem for the treatment of APN caused by 3-GCrEC. A pilot, randomized controlled trial of patients with APN caused by 3-GCrEC was conducted at two hospitals from August 2015 to December 2020. Any intravenous antimicrobial drug was initially permitted for empirical therapy. On day 4, adult patients (aged >18 years) with either non-bacteremic or bacteremic APN were eligible for the study if their infection was caused by 3-GCrEC susceptible to the study drugs. The patients were randomly assigned to receive either oral prulifloxacin or intravenous ertapenem. The total duration of antimicrobial therapy was 14 days. Of the 21 enrolled patients, 11 were treated with prulifloxacin, and 10 were treated with ertapenem. At the test of cure visit, there was no statistically significant difference between the patients with overall clinical success who were treated with prulifloxacin (90.9%) and those treated with ertapenem (100%, p = 0.999). In addition, there was no statistically significant difference in microbiological eradication between the prulifloxacin and ertapenem groups (100% vs. 100%, p = 0.999). The converting to oral prulifloxacin after intravenous antibiotics therapy appears to be an alternative option for treatment of APN caused by 3-GCrEC. A further large randomized controlled trial should be investigated.
Topics: Adult; Humans; Anti-Bacterial Agents; Carbapenems; Ertapenem; Fluoroquinolones; Pilot Projects; Pyelonephritis; Third Generation Cephalosporins
PubMed: 37853952
DOI: 10.1111/cts.13665 -
Balkan Medical Journal Jan 2024
Topics: Humans; Diabetes Mellitus, Type 2; Klebsiella; Pyelonephritis; Cystitis
PubMed: 37815233
DOI: 10.4274/balkanmedj.galenos.2023.2023-8-77 -
CEN Case Reports Jun 2024Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection characterized by gas retention and a poor prognosis. We present the case of a 75-year-old man who...
Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection characterized by gas retention and a poor prognosis. We present the case of a 75-year-old man who was diagnosed early with EPN and received multidisciplinary treatment. He had poorly controlled type 2 diabetes mellitus (DM) and chronic kidney disease (CKD), and was treated with oral hypoglycemic drugs, including a sodium-glucose co-transporter-2 inhibitor. He experienced the onset of back pain in the midsection of his back, tenderness in the costovertebral angle, and a high fever (> 39 °C), accompanied by tachycardia, hypotension, and tachypnea. The patient was diagnosed with pyelonephritis and septic shock. Immediate measures encompassing empirical antibiotic therapy, administration of noradrenaline, blood glucose regulation, and urethral catheterization were implemented. However, due to the persistent fever (> 38 °C) and lack of improvement in his condition, abdominal computed tomography (CT) was repeated on the fourth day. This revealed the presence of gas around the right kidney parenchyma, leading to a diagnosis of EPN that had evolved from acute pyelonephritis. Subsequently, percutaneous drainage of the right kidney parenchyma was performed. Subsequently, multidisciplinary treatment was continued, and his condition gradually improved. Clinicians should evaluate abdominal CT when acute pyelonephritis does not improve within a few days of antibiotic therapy. Disease progression from acute pyelonephritis to EPN should be considered in patients with DM and CKD.
Topics: Humans; Male; Diabetes Mellitus, Type 2; Aged; Pyelonephritis; Emphysema; Tomography, X-Ray Computed; Anti-Bacterial Agents; Renal Insufficiency, Chronic; Shock, Septic; Drainage; Hypoglycemic Agents
PubMed: 37737333
DOI: 10.1007/s13730-023-00821-7 -
Epidemiology and Infection Sep 2023Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the...
Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% ), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.
Topics: Adult; Male; Humans; Female; Cross-Sectional Studies; Escherichia coli; Urinary Diversion; Pyelonephritis; Urolithiasis; France
PubMed: 37721009
DOI: 10.1017/S0950268823001504 -
CEN Case Reports Jun 2024We report co-occurrence of emphysematous cystitis and emphysematous pyelonephritis (EC/EPN) in a 64-year-old female with poor-controlled diabetes mellitus (DM) that...
We report co-occurrence of emphysematous cystitis and emphysematous pyelonephritis (EC/EPN) in a 64-year-old female with poor-controlled diabetes mellitus (DM) that presented with flank pain, fever, and hematuria that turned out to have a bilateral extrarenal pelvis. On examination, she was feverish, and the costovertebral angle was tender. By considering herhemoglobin A1C, her DM was out of control. Inflammatory markers elevated. Renal function tests were impaired. Urine culture was positive for extended-spectrum beta-lactamase Escherichia coli. Computed tomography scans (CT) confirmed the presence of air in the bladder and renal pelvis in favor of EC and unilateral EPN. We planned to use conservative treatments. Promptly intravenous antibiotics started; thereafter, the renal pelvis was drained via percutaneous catheter, and the bladder was drained via foley catheter, as well. After 14 days of hospitalization, clinical status improved, urine culture got negative, and emphysema in follow-up CT images wholly regressed. To our knowledge, co-occurrence of emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) in a patient with an extra renal pelvis never happened. We tend to convey messages, including (1) the extrarenal pelvis may contribute to predisposing the patient to pyelonephritis if it is considerably large; (2) the conservative plan and observation was a successful experience in treating extrarenal pelvis patients with EC/EPN.
Topics: Humans; Female; Pyelonephritis; Middle Aged; Cystitis; Emphysema; Tomography, X-Ray Computed; Anti-Bacterial Agents; Escherichia coli Infections; Kidney Pelvis; Escherichia coli; Drainage; Treatment Outcome
PubMed: 37676477
DOI: 10.1007/s13730-023-00816-4 -
Urology Annals 2023Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was...
Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was emphysematous pyelitis, which was considered the first report in the literature as far as we know.
PubMed: 37664102
DOI: 10.4103/ua.ua_27_22 -
Irish Journal of Medical Science Apr 2024Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted...
BACKGROUND
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted antibiotic therapy and surgical removal of the affected kidney.
AIM
We report the outcomes of patients undergoing nephrectomy for XGP in our institution over a 12-year period.
METHODS
Following ethical approval, a retrospective review of histological samples of renal tissue demonstrating features of XGP from June 2010 to 2022 was conducted. Laboratory, imaging, and clinical data of included participants were collected.
RESULTS
Eleven patients were included (8 women, 3 men), mean age of 58.1 (35-81). Recurrent urinary tract infection was the most common clinical presentation (55%, n = 6). Other presentations included flank pain (36%, n = 4), collection/ abscess (45%, n = 5), and nephro-cutaneous fistulae (9%, n = 1). The majority of patients had bacteriuria (91%, n = 10), and Escherichia coli was the most common bacteria isolated (55%, n = 6). Antibiotic resistance was seen in 60% of positive urine samples (n = 6). An open nephrectomy was performed in all but one case (91%, n = 10). A postoperative complication occurred in 73% (n = 8), with 50% (n = 4) of complications Clavien Dindo grade 3 or higher, including one patient mortality.
CONCLUSIONS
XGP is a difficult and complex condition to treat. All patients in this series presented with infection or associated sequelae thereof. Complex XGP cases therefore often require open nephrectomy and have high rates of postoperative complications. Careful consideration of antibiotic and operative intervention is therefore essential to ensure the best outcome for these patients.
Topics: Male; Humans; Female; Middle Aged; Pyelonephritis, Xanthogranulomatous; Diagnostic Imaging; Retrospective Studies; Nephrectomy; Urinary Tract Infections; Postoperative Complications; Anti-Bacterial Agents
PubMed: 37610600
DOI: 10.1007/s11845-023-03496-2