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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 -
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 -
MSphere Oct 2023is the most common cause of urinary tract infections (UTIs) in children, and yet the underlying mechanisms of virulence and antibiotic resistance and the overall...
is the most common cause of urinary tract infections (UTIs) in children, and yet the underlying mechanisms of virulence and antibiotic resistance and the overall population structure of the species is poorly understood within this age group. To investigate whether uropathogenic (UPEC) from children who developed pyelonephritis carried specific genetic markers, we generated whole-genome sequence data for 96 isolates from children with UTIs. This included 57 isolates from children with either radiologically confirmed pyelonephritis or cystitis and 27 isolates belonging to the well-known multidrug-resistant sequence type ST131, selected to investigate their population structure and antibiotic resistance characteristics. We observed a UPEC population structure that is similar to those reported in adults. In comparison with prior investigations, we found that the full operon was more common among UPEC from pediatric cases of pyelonephritis. Further, in contrast with recent reports that the P-fimbriae adhesin-encoding allele is substantially more prevalent in invasive UPEC from adults, we found was common to both invasive and non-invasive UPEC from children. Among the set of ST131 isolates from children with UTIs, we found antibiotic resistance was correlated with known genetic markers of resistance, as in adults. Unexpectedly, we observed that 30, an allele of the fimbrial gene often used as a proxy to type ST131 isolates into the most drug-resistant subclade C, was carried by some of the subclade A and subclade B isolates, suggesting that the 30 allele could confer a selective advantage for UPEC. IMPORTANCE Urinary tract infections (UTIs), which are most often caused by , are not well studied in children. Here, we examine genetic characteristics that differentiate UTI-causing bacteria in children that either remain localized to the bladder or are involved in more serious kidney infections. We also examine patterns of antibiotic resistance among strains from children that are part of sequence type 131, a group of bacteria that commonly cause UTIs and are known to have high levels of drug resistance. This work provides new insight into the virulence and antibiotic resistance characteristics of the bacteria that cause UTIs in children.
Topics: Adult; Humans; Child; United States; Uropathogenic Escherichia coli; Anti-Bacterial Agents; Escherichia coli Infections; Genetic Markers; Virulence Factors; Urinary Tract Infections; Pyelonephritis; Genomics
PubMed: 37581436
DOI: 10.1128/msphere.00184-23 -
International Urology and Nephrology Dec 2023Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score...
INTRODUCTION
Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient.
PATIENTS AND METHODS
In this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22.
RESULTS
Mean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively.
CONCLUSION
NEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit.
Topics: Humans; Middle Aged; Critical Care; Hospital Mortality; Intensive Care Units; Prognosis; Pyelonephritis; Retrospective Studies; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome
PubMed: 37556105
DOI: 10.1007/s11255-023-03733-8 -
Urology Case Reports Sep 2023Gas-containing renal stones (GCS) are rare urological entities. Current literature has suggested possible associations with premenopausal women, urinary tract infection,...
Gas-containing renal stones (GCS) are rare urological entities. Current literature has suggested possible associations with premenopausal women, urinary tract infection, and metabolic diseases. We report the case of a 25-year-old young woman with no underlying co-morbidities who had multiple right GCS and suspected emphysematous pyelitis. Antibiotic therapy was initiated to control her urinary tract infection with . She then underwent elective right flexible ureteroscopy to relieve her ureteropelvic junction obstruction. Complete stone retrieval was achieved and she made an uneventful recovery with no stone recurrence during 1-year follow-up.
PubMed: 37484193
DOI: 10.1016/j.eucr.2023.102500 -
Nature Reviews. Nephrology Oct 2023Urinary tract infections (UTIs) are among the most common bacterial infections seen in clinical practice. The ascent of UTI-causing pathogens to the kidneys results in... (Review)
Review
Urinary tract infections (UTIs) are among the most common bacterial infections seen in clinical practice. The ascent of UTI-causing pathogens to the kidneys results in pyelonephritis, which can trigger kidney injury, scarring and ultimately impair kidney function. Despite sizable efforts to understand how infections develop or are cleared in the bladder, our appreciation of the mechanisms by which infections develop, progress or are eradicated in the kidney is limited. The identification of virulence factors that are produced by uropathogenic Escherichia coli to promote pyelonephritis have begun to fill this knowledge gap, as have insights into the mechanisms by which kidney tubular epithelial cells oppose uropathogenic E. coli infection to prevent or eradicate UTIs. Emerging data also illustrate how specific cellular immune responses eradicate infection whereas other immune cell populations promote kidney injury. Insights into the mechanisms by which uropathogenic E. coli circumvent host immune defences or antibiotic therapy to cause pyelonephritis is paramount to the development of new prevention and treatment strategies to mitigate pyelonephritis and its associated complications.
Topics: Humans; Escherichia coli; Pyelonephritis; Kidney; Epithelial Cells
PubMed: 37479904
DOI: 10.1038/s41581-023-00737-6