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Transplantation Direct Jun 2023Ureteric encrustation and lithiasis after renal transplantation are rare but not without risk of obstruction and graft loss. Patients are usually asymptomatic, and a...
Ureteric encrustation and lithiasis after renal transplantation are rare but not without risk of obstruction and graft loss. Patients are usually asymptomatic, and a majority present with graft dysfunction with imaging demonstrating hydronephrosis and rarely with acute graft pyelonephritis. We compare a case of transplant lithiasis with encrusted pyelitis and highlight key differences in their presentation and workup. A key focus for transplant physicians is to recognize when dealing with transplant hydronephrosis that the presence of a high urine pH and pyuria should be a key indicator to suspect ureteric encrustation to look for a urease-producing organism, recognizing that such organisms require prolonged incubation with urine culturing for up to 72 h.
PubMed: 37197017
DOI: 10.1097/TXD.0000000000001468 -
Annals of Transplantation May 2023BACKGROUND Carbapenems are the primary treatment for urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae.... (Observational Study)
Observational Study
Breaking Antimicrobial Resistance: High-Dose Amoxicillin with Clavulanic Acid for Urinary Tract Infections Due to Extended-Spectrum Beta-Lactamase (ESBL)-Producing Klebsiella pneumoniae.
BACKGROUND Carbapenems are the primary treatment for urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae. However, the recurrence rate is high, and patients often require rehospitalization. We present the results of an observational study on patients with recurrent UTIs who were treated in an outpatient setting with maximal therapeutic oral doses of amoxicillin with clavulanic acid. MATERIAL AND METHODS All patients had pyuria and ESBL-producing K. pneumoniae in urine culture. The starting dosage was 2875 g of amoxicillin twice daily and 125 mg of clavulanic acid twice daily. We down-titrated the doses every 7-14 days and continued prophylactic therapy with amoxicillin/clavulanic acid at 250/125 mg for up to 3 months. We defined therapeutic failure as ESBL-positive K. pneumoniae in urine culture during therapy and recurrence as positive urine culture with the same strain within 1 month after the end of treatment. RESULTS We included 9 patients: 7 kidney graft recipients, 1 liver graft recipient, and 1 patient with chronic kidney disease. We observed no therapeutic failures and no recurrences in the study group during the study period. In 1 case, the patient experienced a subsequent UTI caused by ESBL-producing K. pneumoniae 4 months after completing the therapy. CONCLUSIONS In conclusion, it is possible to break the resistance of ESBL-producing K. pneumoniae strains with high doses of oral amoxicillin with clavulanic acid. Such treatment could be an alternative to carbapenems in select cases.
Topics: Humans; Klebsiella pneumoniae; Anti-Bacterial Agents; Amoxicillin; Clavulanic Acid; Klebsiella Infections; Microbial Sensitivity Tests; Drug Resistance, Bacterial; Urinary Tract Infections; Carbapenems; beta-Lactamases
PubMed: 37190675
DOI: 10.12659/AOT.939258 -
Journal of the Formosan Medical... Oct 2023/Purpose: Reactivity at the Bacillus Calmette-Guérin (BCG) scar is a pathognomonic feature of Kawasaki disease (KD). However, its value in predicting KD outcomes has...
BACKGROUND
/Purpose: Reactivity at the Bacillus Calmette-Guérin (BCG) scar is a pathognomonic feature of Kawasaki disease (KD). However, its value in predicting KD outcomes has not been emphasized. This study explored the clinical significance of BCG scar redness with respect to coronary artery outcomes.
METHODS
This retrospective study collected data on children with KD from 13 hospitals in Taiwan during 2019-2021. Children with KD were categorized into four groups based on the KD type and BCG scar reactivity. Risk factors of coronary artery abnormalities (CAA) were analyzed in all groups.
RESULTS
BCG scar redness occurred in 49% of 388 children with KD. BCG scar redness was associated with younger age, early intravenous immunoglobulin (IVIG) treatment, hypoalbuminemia, and CAA at the first echocardiogram (p < 0.01). BCG scar redness (RR 0.56) and pyuria (RR 2.61) were independent predictors of any CAA within 1 month (p < 0.05). Moreover, pyuria (RR 5.85, p < 0.05) in children with complete KD plus BCG scar redness was associated with CAA at 2-3 months; first IVIG resistance (RR 15.2) and neutrophil levels ≥80% (RR 8.37) in children with complete KD plus BCG scar non-redness were associated with CAA at 2-3 months (p < 0.05). We failed to detect any significant risk factors of CAA at 2-3 months in children with incomplete KD.
CONCLUSION
BCG scar reactivity contributes to diverse clinical features in KD. It can be effectively applied to determine the risk factors of any CAA within 1 month and CAA at 2-3 months.
Topics: Child; Humans; Infant; BCG Vaccine; Cicatrix; Coronary Artery Disease; Immunoglobulins, Intravenous; Mucocutaneous Lymph Node Syndrome; Pyuria; Retrospective Studies
PubMed: 37142476
DOI: 10.1016/j.jfma.2023.04.016 -
Cureus Mar 2023Acute tubulointerstitial nephritis (ATIN) is an infiltration of the kidney interstitium with inflammatory cells. Medications are most frequently blamed for the etiology....
OBJECTIVE
Acute tubulointerstitial nephritis (ATIN) is an infiltration of the kidney interstitium with inflammatory cells. Medications are most frequently blamed for the etiology. Patients may present with non-specific signs and symptoms. Therefore, the diagnosis of ATIN is often delayed. In this study, clinical characteristics, treatment protocols, and outcomes of children diagnosed with ATIN were presented.
METHODS
This is a retrospective study based on the data of 18 patients diagnosed with ATIN between 2017 and 2022 at Gazi University. Patients were divided into two groups: steroid-treated (n=13) and non-steroid-treated (n=5). Clinical features and laboratory evaluations were compared between the groups.
RESULTS
The mean age of the patients was 14.4±2.6 years, and the great majority were girls (88.9%, n=16). ATIN was mostly medication-related (n=17, 94.4%). Steroids were started in one-third of patients using non-steroidal anti-inflammatory drugs. Steroids were started in 45.4% of the patients with eosinophilia, 75% of those with pyuria, 66.6% of those with hematuria, and half of the patients with increased kidney echogenicity. The kidney functions returned to normal ranges in all patients. In steroid-treated patients, although recovery times for serum creatinine were longer (7.2±2.5 vs. 71.2±100.7 days), blood eosinophil count reached normal values more rapidly (5.4±2.3 vs. 3.1±1.0 days).
CONCLUSION
ATIN can be associated with diverse clinical presentations. The first and most important step of treatment is to discontinue the medication responsible for the etiology. Steroid treatment improves eosinophilia more rapidly. However, randomized controlled studies are needed to determine further treatment steps and establish a more definite treatment protocol.
PubMed: 37090263
DOI: 10.7759/cureus.36379 -
Journal of Veterinary Internal Medicine 2023The ability to detect bacteriuria in dogs with a point-of-care test might improve medical care and antimicrobial stewardship.
BACKGROUND
The ability to detect bacteriuria in dogs with a point-of-care test might improve medical care and antimicrobial stewardship.
HYPOTHESIS AND OBJECTIVE
A rapid immunoassay (RIA; RapidBac) will provide acceptable sensitivity and specificity for diagnosis of bacteriuria.
ANIMALS
Forty-four client-owned dogs with a clinical indication for urinalysis and aerobic bacterial urine culture.
METHODS
Prospective study. Urine, collected by cystocentesis, was submitted for urinalysis and culture at a diagnostic laboratory. Owners completed an enrollment questionnaire regarding their dogs' clinical signs. The RIA was performed according to the manufacturer's guidelines. Results were compared to culture.
RESULTS
Forty-four urine specimens were evaluated from 44 dogs. The sensitivity and specificity of the RIA test to detect bacteriuria compared to urine culture were 81.8% (95% CI, 65.7%-97.9%) and 95.5% (95% CI, 86.8%-99.9%), respectively. For cultures yielding ≥10 CFU/mL, sensitivity increased to 90.0% (95% CI, 76.9%-100%) and specificity was similar at 95.2% (95% CI, 86.1%-99.9%). Malodorous urine, bacteriuria, and pyuria were more likely to be present in dogs with positive RIA or urine culture results compared to dogs with negative results.
CONCLUSIONS AND CLINICAL IMPORTANCE
The RIA was easy to perform and had good sensitivity and excellent specificity in this group of dogs. The RIA might be a useful screening test for decision-making regarding antimicrobial therapy in dogs with a clinical indication for urine culture. Consideration could be given to amending the International Society for Companion Animal Infectious Disease definition of bacterial cystitis as the presence of signs of lower urinary tract disease together with positive culture or a positive RIA.
Topics: Dogs; Animals; Bacteriuria; Prospective Studies; Urinalysis; Bacterial Infections; Radioimmunoassay; Urinary Tract Infections; Dog Diseases
PubMed: 37084042
DOI: 10.1111/jvim.16684 -
IJID Regions Jun 2023Urogenital pathogens such as and have been reported to cause pyuria, however they are not routinely cultured from urine samples of patients clinically diagnosed to...
BACKGROUND
Urogenital pathogens such as and have been reported to cause pyuria, however they are not routinely cultured from urine samples of patients clinically diagnosed to have urinary tract infections (UTI). In this study, pathogen specific PCR was done to identify the urogenital pathogens in the urine samples among clinically diagnosed UTI patients with negative routine urine culture.
METHODS
A cross-sectional study was conducted involving 227 archived urine samples from clinically diagnosed UTI patients with positive leucocyte esterase but negative urine culture results. The urogenital pathogens were detected using pathogen specific singleplex PCR. Data were cleaned and analyzed using STATA version 15.
RESULTS
The median age of patients was 31[IQR 23 - 51] years and the majority (174, 76.7%) were females. Two thirds of patients had history of antibiotic use two weeks prior to recruitment (154, 67.8%). A total of 62(27.3%) urine samples were positive for at least one urogenital pathogen. Of 62 positive samples, 9 had two urogenital pathogens and 1 had three urogenital pathogens. The most predominant urogenital pathogen detected was 25(34.2%) and 24(32.9%). Being female (aOR 2.4; 95% CI: 1.04 - 5.49; p-value 0.039) and having history of using antibiotics in the past two weeks (aOR 1.9; 95%CI: 1.04 - 3.60; p-value 0.036) was independently associated with the presence of urogenital pathogens.
CONCLUSION
More than a quarter of female patients with clinical symptoms of UTI and routine urine culture negative results were infected with urogenital pathogens mainly and . Further research with a larger sample set in a range of settings is required to understand the implications of these finding generally.
PubMed: 37069922
DOI: 10.1016/j.ijregi.2022.12.007 -
Cancers Mar 2023Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer....
Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data.
Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer. However, to our knowledge, none have clarified the risks associated with pyuria according to bacille Calmette-Guerin (BCG) treatment status. We retrospectively selected patients with high-risk non-muscle invasive bladder cancer according to Japanese Urological Association guidelines. Pyuria was defined as ≥10 white blood cells per high-powered field. We analyzed recurrence-free rates (RFS) in 424 patients who had and had not undergone BCG treatment. The median duration of follow-up was 45.2 months. According to multivariate analysis, postoperative intravesical BCG induction and preoperative pyuria were independent risk factors for intravesical recurrence in the whole study cohort. We found no significant risk factors for recurrence in the BCG-treated group ( = 179). In the non-BCG-treated group ( = 245), patients with pyuria were much more frequently female and more often had T1 disease than patients without pyuria. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. There was no significant difference in the severity of pyuria between the BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk NMIBC and pyuria.
PubMed: 36980524
DOI: 10.3390/cancers15061638 -
JAC-antimicrobial Resistance Apr 2023To re-examine the use of non-carbapenems (NCBPs), specifically piperacillin/tazobactam and cefepime, for ESBL-producing Enterobacterales (ESBL-E) urinary tract...
OBJECTIVES
To re-examine the use of non-carbapenems (NCBPs), specifically piperacillin/tazobactam and cefepime, for ESBL-producing Enterobacterales (ESBL-E) urinary tract infections (UTIs).
PATIENTS
Retrospective cohort study of adults hospitalized between January 2016 and June 2020 with pyuria on urinalysis, a urine culture positive for ESBL-E treated with a study antibiotic (meropenem, ertapenem, cefepime or piperacillin/tazobactam) and did not meet criteria for study exclusion.
METHODS
To compare carbapenems (CBPs) with cefepime or piperacillin/tazobactam for the treatment of ESBL-E UTI. The primary outcome was clinical cure, defined as complete resolution of signs and symptoms of infection. Secondary outcomes included in-hospital mortality, recurrence within 30 days and resistance emergence within 30 days.
RESULTS
One-hundred and thirty-three patients were included, based on definitive therapy received; 69 (51.9%) received CBP and 64 (48.1%) received NCBP therapy. Of the total patient population, 17 (12.8%) were admitted to the ICU, 84 (63.1%) had a complicated UTI and 64 (48.1%) had pyelonephritis. There was no difference in clinical cure between the CBP and NCBP groups (95.7% versus 96.9%, = 0.999). Additionally, no differences in secondary outcomes were observed.
CONCLUSIONS
When compared with CBPs, cefepime and piperacillin/tazobactam resulted in similar clinical cure, in-hospital mortality, recurrence and resistance emergence in the treatment of ESBL-E UTI.
PubMed: 36936190
DOI: 10.1093/jacamr/dlad021 -
POCUS Journal 2022A 63-year-old man with past history of multiple myeloma recently started on a regimen of daratumumab, carfilzomib, and dexamethasone was referred to our emergency...
A 63-year-old man with past history of multiple myeloma recently started on a regimen of daratumumab, carfilzomib, and dexamethasone was referred to our emergency department for a rapidly rising serum creatinine as high as 10 mg/dL. He complained of fatigue, nausea, and poor appetite. Exam revealed hypertension, but no edema or rales. Labs were consistent with AKI without hypercalcemia or evidence of hemolysis or tumor lysis. Urinalysis and urine sediment were bland without proteinuria, hematuria, or pyuria. Initial concern was for hypovolemia or myeloma cast nephropathy. POCUS revealed no overt evidence of volume overload or depletion, instead revealing bilateral hydronephrosis. Bilateral percutaneous nephrostomies were placed with resolution of the AKI. Ultimately, referral imaging revealed interval progression of bulky retroperitoneal extramedullary plasmacytomas compressing the ureters bilaterally related to the underlying multiple myeloma.
PubMed: 36896099
DOI: 10.24908/pocus.v7iKidney.15342 -
Pathogens (Basel, Switzerland) Jan 2023There is a growing body of evidence on the potential involvement of coagulase-negative Staphylococci (CoNS) in causing urinary tract infections (UTIs). The aim of this...
BACKGROUND
There is a growing body of evidence on the potential involvement of coagulase-negative Staphylococci (CoNS) in causing urinary tract infections (UTIs). The aim of this study was to delineate virulence potential, antimicrobial resistance genes, and sequence types of CoNS isolated from patients with UTI symptoms and pyuria in Tanzania.
METHODS
CoNS from patients with UTI symptoms and more than 125 leucocytes/μL were retrieved, subcultured, and whole-genome sequenced.
RESULTS
Out of 65 CoNS isolates, 8 species of CoNS were identified; , = 27 (41.5%), and , = 24 (36.9%), were predominant. The majority of were sequence type (ST) 30, with 8 new ST138-145 reported, while the majority of were typed as ST490 with 7 new ST1184-1190 reported. Sixty isolates (92.3%) had either one or multiple antimicrobial resistance genes. The most frequently detected resistance genes were 53 (21%) G, 32 (12.9%) Z, and 26 (10.5%) mecA genes conferring resistance to trimethoprim, penicillin, and methicillin, respectively. Out of 65 isolates, 59 (90.8%) had virulence genes associated with UTI, with a predominance of the C 47 (46.5%) and A 14 (13.9%) genes. and harboring C, G, Z, and A genes were the predominant CoNS causing UTI in Tanzania. Laboratories should carefully interpret the significant bacteriuria due to CoNS in relation to UTI symptoms and pyuria before labeling them as contaminants. Follow-up studies to document the outcome of the treated patients is needed to add more evidence that CoNS are UTI pathogens.
PubMed: 36839452
DOI: 10.3390/pathogens12020180