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BMJ Case Reports Feb 2024A man in his 50s with diabetes presented with backache, left flank pain and fever. On evaluation, he was found to have emphysematous pyelonephritis of the left kidney...
A man in his 50s with diabetes presented with backache, left flank pain and fever. On evaluation, he was found to have emphysematous pyelonephritis of the left kidney with a paranephric abscess extending into the posterior abdominal wall and superiorly up to the posterior chest wall and inferiorly extending up to the posterior superior iliac spine. The management involved the initiation of broad-spectrum antibiotics and percutaneous drainage of the abscess. However, as he continued to worsen symptoms-wise, he underwent computed-enhanced CT of the abdomen and thorax. The imaging revealed the presence of a purulent collection in the left lumbar region with an extension along the posterior cervical region and the retropharyngeal space. He underwent a fasciotomy of the lumbar region. The occurrence of emphysematous pyelonephritis along with necrotising fasciitis is uncommon and requires early aggressive management with broad-spectrum antibiotics and adequate drainage. This emphasises the need for early reimaging if the patient does not settle with antibiotics or percutaneous drainage.
Topics: Humans; Male; Abscess; Anti-Bacterial Agents; Diabetes Complications; Emphysema; Fasciitis, Necrotizing; Pyelonephritis; Middle Aged
PubMed: 38320824
DOI: 10.1136/bcr-2023-257014 -
Harefuah Jan 2024Antibiotic resistance is a worldwide concern. No study has ever examined the correlation between ethnicity and antibiotic resistance. We examined those parameters among...
[EFFECT OF ETHNICITY ON BACTERIAL RESISTANCE AND OBSTETRICAL OUTCOMES AMONG PREGNANT WOMEN ADMITTED TO MATERNAL-FETAL MEDICINE UNIT WITH THE DIAGNOSIS OF PYELONEPHRITIS DURING 2017-2020].
INTRODUCTION
Antibiotic resistance is a worldwide concern. No study has ever examined the correlation between ethnicity and antibiotic resistance. We examined those parameters among hospitalized pregnant patients diagnosed with pyelonephritis.
AIMS
Should ethnic origin play a role in optimizing antibiotic therapy? To better comprehend, we have chosen a cohort of hospitalized pregnant patients with a pyelonephritis diagnosis.
METHODS
A total of 105 cases of patients hospitalized in the Shamir Medical Center between the years 2017-2020 were analysed. Feto-maternal outcomes and antibiotic resistance in relation to ethnicity were plotted statistically using chi-square tests (Arab, 40%; North Africa, 13%; Europe-Ashkenaz,10%; Ethiopia/Iran/Kavkaz/Iraq/other, 3%; Turkey/Uzbekistan/Yemen 2%).
RESULTS
Ethnic groups included Arab (40%), others referred as "None-Arab". The antibiotic resistance panel revealed differences comparing the two largest groups (Arab% VS non-Arab%), whereas there was no correlation between any ethnic group and obstetrics parameter. Arab women were more resistant to ciprofloxacin (33% vs 7%, P= 0.026) and less sensitive to imipenem (60% vs 90.9%, P= 0.03); less sensitive to ceftriaxone and cefuroxime.
CONCLUSIONS
There was a correlation between ethnic origin of pregnant patients diagnosed with pyelonephritis and antibiotic resistance. We hope ethnicity, might, in some cases, assist physicians choosing the optimal therapy.
Topics: Female; Humans; Pregnancy; Ethnicity; Pregnant Women; Perinatology; Anti-Bacterial Agents; Pyelonephritis
PubMed: 38297416
DOI: No ID Found -
Kidney International Apr 2024Little is known about the effect tubulointerstitial nephropathies have in modulating maternal-fetal outcomes in pregnancy. Therefore, we analyzed the main outcomes of... (Observational Study)
Observational Study
Little is known about the effect tubulointerstitial nephropathies have in modulating maternal-fetal outcomes in pregnancy. Therefore, we analyzed the main outcomes of pregnancy in these women to gain a better understanding of the role of a reduction in maternal kidney mass. From the Torino Cagliari Observational Study (TOCOS) cohort, we selected 529 patients with a diagnosis of tubulointerstitial disease and focused on 421 patients with chronic kidney disease (CKD) stage 1, without hypertension but with proteinuria less than 0.5 g/day at referral. From a cohort of 2969 singleton deliveries from low-risk pregnancies followed in the same settings we selected a propensity score matched control cohort of 842 pregnancies match 2:1 for age, parity, body mass index, ethnicity, and origin. Time to delivery was significantly shorter in the study cohort 38.0 (Quartile 1-Quartile 3: 37.0-39.0) versus 39.0 (Q1-Q3 38.0-40.0) weeks, with respect to controls. Incidence of delivery of less than 37 gestational weeks significantly increased from controls (7.4%) to women with previous acute pyelonephritis (10.8%), other tubulointerstitial diseases (9.7%) and was the highest in patients with a single kidney (31.1%). Similarly, neonatal birthweight significantly and progressively decreased from controls (3260 g [Q1-Q3: 2980-3530]), previous acute pyelonephritis (3090 g [Q1-Q3: 2868-3405], other tubulointerstitial diseases (3110 g [Q1-Q3: 2840-3417]), and to solitary kidney (2910 g [Q1-Q3: 2480-3240]). Risk of developing preeclampsia was significantly higher in the CKD cohort (3.6% vs 1.7% in low-risk controls). Thus, even a small reduction in functional kidney mass, such as a pyelonephritic scar, is associated with a shorter duration of pregnancy and an increased risk of preterm delivery. The risk is proportional to the extent of parenchymal reduction and is highest in cases with a solitary kidney.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Pregnancy Outcome; Solitary Kidney; Renal Insufficiency, Chronic; Kidney; Pyelonephritis
PubMed: 38296027
DOI: 10.1016/j.kint.2023.12.018 -
Emergency Radiology Apr 2024Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with... (Review)
Review
Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
Topics: Female; Humans; Middle Aged; Pyelonephritis; Emphysema; Tomography, X-Ray Computed; Osteomyelitis
PubMed: 38267799
DOI: 10.1007/s10140-024-02203-7 -
Khirurgiia 2024Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis,...
OBJECTIVE
Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction.
MATERIAL AND METHODS
Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup).
RESULTS
In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology.
CONCLUSION
Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.
Topics: Humans; Animals; Dogs; Acute Disease; Pancreatitis; Kidney; Pyelonephritis; Intestinal Obstruction; Peritonitis; Succinates
PubMed: 38258686
DOI: 10.17116/hirurgia202401134 -
Asian Journal of Surgery May 2024
Topics: Humans; Male; Kidney Tubules, Collecting; Pyelonephritis; Ureterocele; Middle Aged
PubMed: 38242794
DOI: 10.1016/j.asjsur.2024.01.057 -
Saudi Journal of Kidney Diseases and... May 2023Psoas muscle abscesses associated with emphysematous urinary tract infections are rare. There are not many case reports about urinary tract infections such as...
Psoas muscle abscesses associated with emphysematous urinary tract infections are rare. There are not many case reports about urinary tract infections such as emphysematous pyelitis and emphysematous cystitis complicating psoas muscle abscesses. Here, we report a case of an ipsilateral psoas muscle abscess following emphysematous cystitis and emphysematous pyelitis in an 81-year-old diabetic man. He was treated with prolonged antibiotic therapy and other supportive care.
Topics: Male; Humans; Aged, 80 and over; Abscess; Cystitis; Pyelitis; Urinary Tract Infections; Emphysema
PubMed: 38231725
DOI: 10.4103/1319-2442.394003 -
MBio Feb 2024Urinary tract infections (UTIs) in men are uncommon yet carry an increased risk for severe pyelonephritis and other complications. In models of UTI, C3H/HeN mice...
Urinary tract infections (UTIs) in men are uncommon yet carry an increased risk for severe pyelonephritis and other complications. In models of UTI, C3H/HeN mice develop high-titer pyelonephritis (most with renal abscesses) in a testosterone-dependent manner, but the mechanisms underlying this phenotype are unknown. Here, using female mouse models, we show that androgen exposure impairs neutrophil maturation in the upper and lower urinary tract, compounded by a reduction of neutrophil function within the infected kidney, enabling persistent high-titer infection and promoting abscess formation. Following intravesical inoculation with uropathogenic (UPEC), kidneys of androgen-exposed C3H mice showed delayed local pro-inflammatory cytokine responses while robustly recruiting neutrophils. These were enriched for an end-organ-specific population of aged but immature neutrophils (CD49d+, CD101-). Compared to their mature counterparts, these aged immature kidney neutrophils exhibited reduced function , including impaired degranulation and diminished phagocytic activity, while splenic, bone marrow, and bladder neutrophils did not display these alterations. Furthermore, aged immature neutrophils manifested little phagocytic activity within intratubular UPEC communities . Experiments with B6 conditional androgen receptor (AR)-deficient mice indicated rescue of the maturation defect when AR was deleted in myeloid cells. We conclude that the recognized enhancement of UTI severity by androgens is attributable, at least in part, to local impairment of neutrophil maturation in the urinary tract (largely via cell-intrinsic AR signaling) and a kidney-specific reduction in neutrophil antimicrobial capacity.IMPORTANCEAlthough urinary tract infections (UTIs) predominantly occur in women, male UTIs carry an increased risk of morbidity and mortality. Pyelonephritis in androgen-exposed mice features robust neutrophil recruitment and abscess formation, while bacterial load remains consistently high. Here, we demonstrate that during UTI, neutrophils infiltrating the urinary tract of androgen-exposed mice exhibit reduced maturation, and those that have infiltrated the kidney have reduced phagocytic and degranulation functions, limiting their ability to effectively control infection. This work helps to elucidate mechanisms by which androgens enhance UTI susceptibility and severity, illuminating why male patients may be predisposed to severe outcomes of pyelonephritis.
Topics: Female; Humans; Male; Animals; Mice; Aged; Androgens; Neutrophils; Escherichia coli; Abscess; Escherichia coli Infections; Mice, Inbred C3H; Kidney; Urinary Tract Infections; Pyelonephritis; Uropathogenic Escherichia coli
PubMed: 38206009
DOI: 10.1128/mbio.03170-23 -
Journal of Infection and Public Health Feb 2024This study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN).
BACKGROUND
This study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN).
METHODS
A retrospective cohort study was conducted at a tertiary care hospital in South Korea from July 2019 to December 2021. All female patients aged ≥ 19 years who were diagnosed with community-acquired APN on admission were enrolled. The recurrent group included patients with APN who experienced urinary tract infections within the previous year. The clinical characteristics, types of causative organisms, major antibiotic resistance, and molecular characteristics of Escherichia coli strains were compared between the recurrent and non-recurrent groups.
RESULTS
A total of 285 patients with APN were analyzed, including 41 (14.4%) in the recurrent group. Compared to the non-recurrent group, the recurrent group had a higher Charlson Comorbidity Index (1.8 ± 2.1 vs. 1.1 ± 1.5; P = 0.01) and a higher proportion of bladder abnormalities, such as neurogenic bladder (12.2% vs. 2.0%; P = 0.001) and urinary catheterization (12.2% vs. 1.6%; P < 0.001). Escherichia coli was the most common causative organism in both groups. The proportion of Klebsiella pneumoniae (17.1% vs. 4.7%; P = 0.007) and Pseudomonas aeruginosa (5.7% vs. 0.5%; P = 0.014) as a causative organism was higher in the recurrent group. Regarding the microbiological characteristics of Escherichia coli, there were no significant differences in the proportion of antibiotic resistance, phylogenetic groups, resistance genes, and virulence factors between the two groups. Multivariable analysis showed that neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were significantly associated with recurrent APN.
CONCLUSIONS
The proportion of causative organisms except Escherichia coli was higher in the recurrent group than in the non-recurrent group. Neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were risk factors for recurrent APN.
Topics: Humans; Female; Escherichia coli Infections; Retrospective Studies; Urinary Bladder, Neurogenic; Phylogeny; Community-Acquired Infections; Urinary Tract Infections; Pyelonephritis; Anti-Bacterial Agents; Escherichia coli
PubMed: 38198967
DOI: 10.1016/j.jiph.2023.12.011