Characteristics of Sepsis or Acute Pyelonephritis Combined with Ureteral Stone in the United States: A Retrospective Analysis of Large National Cohort

Giudice, Francesco Del; Yoo, Koo Han; Lee, Sinyeong; Oh, Jin Kyu; Cho, Hyuk Jin; Kim, Sang-Youn; Min, Gyeong Eun; Lee, Sang Hyub; Kim, Wansuk; Li, Shufeng; Wei, Wuran; Huang, Jianlin; Brown, David R.; Spradling, Kyle; Basran, Satvir; Belladelli, Federico; Autorino, Riccardo; Pandolfo, Savio Domenico; Crivellaro, Simone; Crocetto, Felice; Ferro, Matteo; Asero, Vincenzo; Scornajenghi, Carlo Maria; Bologna, Eugenio; Sciarra, Alessandro; Salciccia, Stefano; Berardinis, Ettore De; Ricciuti, Gian Piero; Uem, Stefanie van; Conti, Simon; Chung, Benjamin I.

doi:10.3390/app122110718

Cited by 3 publications

(5 citation statements)

References 33 publications

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“…The standard definition of complications was used, as any adverse event occurring within 30 days, and quantified by the modified Clavien–Dindo classification system. A large scale study from the United States describes the characteristics of sepsis and acute pyelonephritis associated with upper urinary tract stones, setting a baseline for better managing these patients in the future [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Mini-Perc for Renal Stones—A Single Center Experience and Literature Review

et al. 2023

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Aim: The aim of this study was to analyze the outcomes of miniaturized nephrolithotomy (mini-perc) in the management of renal stones with a diameter smaller than 20 mm. Materials and Methods: We retrospectively reviewed the records of 102 patients who underwent mini-perc between March 2015 and March 2020 in our department. The primary objective was the stone-free rate, but we also analyzed the retreatment rate, complications, hospital stay, operative time and reduction in hemoglobin level. All these patients had this technique as their first-line treatment, in a prone position, using a 16 Fr sheath size. Data were compared to a series of patients from the literature, treated with conventional PCNL. Results: The patients had calculus limited to either a single calyx or just extending to the renal pelvis, and stone size was less than 20 mm in its maximal dimension. The intrarenal stone location was in the upper calyx in 7 cases, middle calyx in 20 cases and lower calyx in 46 cases, and there were 29 patients with renal pelvis stone. The male to female ratio was 1.5:1, and the median age was 48.4 years. The average stone size was 17.4 mm in diameter (ranging between 9 and 20 mm) and all cases underwent Ho-YaG laser lithotripsy, ballistic energy and combined ultrasonic and ballistic lithotripsy. At the end of the procedure, an antegrade double J stent was placed under fluoroscopy for a maximum of 2 weeks in 42 cases, while 9 cases needed a nephrostomy tube 12–14 F. A total of 51 cases were totally tubeless. Our median operative time was 61 min (ranging from 35 to 75 min). The median hospitalization stay was 3.8 days. The stone free rate was 90.1% after one procedure, only nine (8.8%) cases needed a “second look” flexible ureteroscopy, and the final stone-free rate was 98% (absence of detectable calculi on ultrasound, KUB or non-contrast CT scan). The overall complication rate was 6.86% (Clavien classification I—57.14%; II—28.5%; III—14.2%), while no Clavien IV or V complications were reported. No patient required a blood transfusion, and mean hemoglobin loss was 0.81 mg/dL. Overall, our results are better than similar data for conventional PCNL in the literature. Conclusions: The “mini-perc” technique is an effective procedure for the treatment of the renal lithiasis that is less or equal to 2 cm. The results demonstrated that this minimally invasive technique is associated with a higher stone-free rate and minimal complications.

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Section: Discussionmentioning

confidence: 99%

Mini-Perc for Renal Stones—A Single Center Experience and Literature Review

et al. 2023

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“…In Europe, data from Italy and Greece show that CRE pathogens contribute to an estimated 30,000 deaths annually [14,15]. The United States faces around 9000 healthcareassociated CRE infections each year, leading to approximately 600 deaths, which equates to a 6.6% mortality rate [16][17][18]. The situation is even more dire in developing regions such as Asia, Africa, and South America, where morbidity and mortality rates from MDR infections are higher [19].…”

Section: Epidemiologymentioning

confidence: 99%

“…The FDA's primary endpoint was the combination of clinical cure and microbiological eradication at the end of the intravenous treatment, while for the EMA, the primary endpoint was microbial eradication at the TOC visit. Out of 545 patients who were randomized and received at least one dose of the antibiotics (272 received M/V, 273 received P/T), the overall response at the TOC time-point (days [15][16][17][18][19] decreased in both groups-compared to the earlier assessment-but remained higher in the M/V group (74.5% vs. 70.3%). M/V resistance was noted in a single case of Enterobacterales (K. pneumoniae carrying OXA-48) and in 43% of P. aeruginosa isolates.…”

Section: Meropenem/vaborbactammentioning

confidence: 99%

Carbapenem-Resistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therapeutic Alternatives

Bologna,

Licari,

Manfredi

et al. 2024

Medicina

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Urinary tract infections (UTIs) are the second most frequent type of infection observed in clinical practice. Gram-negative Enterobacteriaceae are common pathogens in UTIs. Excessive antibiotic use in humans and animals, poor infection control, and increased global travel have accelerated the spread of multidrug-resistant strains (MDR). Carbapenem antibiotics are commonly considered the last line of defense against MDR Gram-negative bacteria; however, their efficacy is now threatened by the increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE). This comprehensive review aims to explore the biological mechanisms underlying carbapenem resistance and to present a focus on therapeutic alternatives currently available for complicated UTIs (cUTIs). A comprehensive bibliographic search was conducted on the PubMed/MEDLINE, Scopus, and Web of Science databases in December 2023. The best evidence on the topic was selected, described, and discussed. Analyzed with particular interest were the clinical trials pivotal to the introduction of new pharmacological treatments in the management of complicated cUTIs. Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. This overview provides a current and comprehensive examination of the treatment options available for CRE infections, offering a valuable resource for understanding this constantly evolving public health challenge.

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“…However, complications due to infections may occur after surgery. Infectious complications may range from localized urinary tract infections to sepsis and systemic inflammatory response syndrome (SIRS) [10].…”

Section: Introductionmentioning

confidence: 99%

“…Sepsis resulting from urosepsis is the most severe complication of RIRS, with an estimated risk of up to 5% [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Sepsis after Retrograde Intrarenal Surgery: Single Center Experience

Kang,

Yoo,

Choi

et al. 2023

Urogenit Tract Infect

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Purpose: To evaluate risk factors for sepsis after retrograde intrarenal surgery for treatment of renal stones. Materials and Methods: We analyzed the clinical data of 243 patients with kidney stones who visited our institution between April 2017 and April 2023. Age, sex, body mass index, underlying disease, location and size of stones, previous history of stones, previous history of urinary tract infections, duration of surgery, preoperative drainage, application of ureteral balloon dilation, and laboratory test results were included in the analysis. Results: The mean age of the patients was 58.4 (±15.0) years; there were more men (53.1%) than women (46.9%). Of the 243 patients, the overall rate of sepsis was 5.8% (n=14) and the total mortality rate was 0.4% (n=1). In univariate analysis, history of urinary tract infection (p=0.019), positive preoperative urine culture test (p=0.009), operative duration of more than 90 min (p=0.004), and application of ureter balloon dilation (p=0.016) were statistically significant. In multivariate analysis, positive finding in the urine culture test performed before surgery (p=0.003), operation duration >90 min (p=0.005), and use of balloon dilation during surgery (p=0.011) were statistically significant. Conclusions: There is a risk of progression to postoperative sepsis if bacteria are detected in the urine culture before surgery, if the operative time exceeds 90 min, or if balloon dilation is performed during surgery. Given that the probability of progression to sepsis is approximately 6%, close observation and active treatment are needed for patients with these risk factors.

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Characteristics of Sepsis or Acute Pyelonephritis Combined with Ureteral Stone in the United States: A Retrospective Analysis of Large National Cohort

Cited by 3 publications

References 33 publications

Mini-Perc for Renal Stones—A Single Center Experience and Literature Review

Mini-Perc for Renal Stones—A Single Center Experience and Literature Review

Carbapenem-Resistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therapeutic Alternatives

Risk Factors for Sepsis after Retrograde Intrarenal Surgery: Single Center Experience

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