Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis

Lu, Yu‐Chuan; Hong, Jian‐Hua; Chiang, Bing-Juin; Pong, Yuan-Hung; Hsueh, Po-Ren; Huang, Chao Yuan; Pu, Yeong-Shiau

doi:10.1097/md.0000000000003573

Cited by 46 publications

(21 citation statements)

References 24 publications

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“…The most specific sign but rare is the perception of a subcutaneous crepitus facing kidney signifying the presence of gas, it is only present in 14% of cases. The causative organism is usually Escherichia coli (60% of cases) but Klebsiella pneumoniae was found in 25% of cases , sometimes Pseudomonas or Proteus mirabilis and vulgaris were found[5] [8]. The germ found in our case is Klebsiella pneumoniae ESBL.…”

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confidence: 74%

“…Over the last two decades, the implementation of PCD techniques facilitates maximum nephron sparing and restoration of renal function. Percutaneous drainage, rather, is now the gold standard of care and definitive management for the majority of patients with EPN [1] [5]. In the world, after the publication of the first case of EPN by Kelly et al in 1898 [6], EPN is currently limited to case series reported [5] [7] [8] [9].…”

Section: Introductionmentioning

confidence: 99%

“…Our case is the first case diagnosed in our clinic. Clinical symptoms are not specific, the usual features is an infectious syndrome with urinary symptoms in a diabetic[5] [12]. The most specific sign but rare is the perception of a subcutaneous crepitus facing kidney signifying the presence of gas, it is only present in 14% of cases.…”

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confidence: 99%

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Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

Sabi¹,

Kaza²,

Amekoudi³

et al. 2016

OJNeph

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Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the EPN is currently limited to case series reported. No cases have been described in black Africa. Aims: Related a first case of EPN diagnosed and treated in the University Hospital Center Sylvanus Olympio of Lomé in Togo. Observation: A 40 years old woman, with antecedent of diabetes presented pyelonephritis emphysematous class 2. She was treated successfully with antibiotic alone without using percutaneous drainage or nephrectomy. Conclusion: As reported in every case series, it was a young diabetic patient with a clinical features of acute pyelonephritis which CT scan had helped lay the EPN class 2 diagnosed. The germ was Klebsiella pneumoniae. She was treated with adapted antibiotic alone.

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confidence: 74%

Section: Introductionmentioning

confidence: 99%

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Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

Sabi¹,

Kaza²,

Amekoudi³

et al. 2016

OJNeph

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“…We observed that conservative management with initial fluid resuscitation and broad-spectrum antibiotics and later antibiotic treatment based on culture is successful. Lu et al have reported third-generation cephalosporins as the recommended initial drug in their patients with EPN and carbapenem in patients with prior hospitalization or antibiotic use; patients needing emergency hemodialysis or developing disseminated intravascular coagulation [ 20 ]. In our patients, we observed that the bacteria were sensitive to piperacillin-tazobactam and meropenem in most patients, while they were resistant to gentamicin and levofloxacin in many patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis

Karthikeyan

Cms

Mallya

et al. 2018

CEJU

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IntroductionEmphysematous pyelonephritis (EPN) is a rare clinical entity, characterized by gas in the renal system, due to an acute, fulminant and potentially fatal necrotizing process with varying clinical presentations. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20–40% in the contemporary meta-analysis.Material and methodsA retrospective record review of inpatients at the Institute of Nephro Urology, Bangalore, India (2007–2014), who were treated after EPN was diagnosed with the aid of a CT (computed tomography) scan.ResultsSixty-six patients (M:F 27:39) treated for EPN over the past seven years with the mean (±SD) age of 52.32 (±12.48) years were analyzed. Median (interquartile range) duration of hospital stay was 8 (11.25) days with 4 (6%) patients requiring intensive care unit admission (median, IQR = 5.5, 1.5 days) of whom two passed away due to septicemia. Fifty-six (84.85%) patients were diabetics, forty (60.6%) patients had estimated glomerular filtration rate (eGFR) <60 ml/min/1.7 3 m2, 6 (9.1%) patients had eGFR <30 ml/min/1.73 m2 including 3 (4.5%) with eGFR <15 ml/min/1.73 m2 requiring hemodialysis and twenty-two (33%) had thrombocytopenia. Fifty (75.76%) patients were classified as Huang and Tseng Class 2, 7 (10%) as Class 3 with perinephric abscess requiring open drainage and 9 (13.64%) had bilateral EPN (Class 4). Majority (43; 65%) responded to piperacillin-tazobactam treatment. Double J stenting was done in 17 (25.76%) patients, percutaneous drainage in 5 (7.58%) patients and nephrectomy in 2 (3%) patients.ConclusionsAlthough EPN historically carries high morbidity and mortality, modern day medical management with timely intervention in the form of urinary drainage is effective and curative in most patients resulting in a low mortality rate.

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“…The single-agent options effective against EPN are at least third-generation cephalosporins and carbapenems. For high-risk patients, the combination of amikacin and third-generation cephalosporin is an option [ 11 ]. In this case, report, we highlighted that the clinical and imaging features of EPN may be helpful for physicians to diagnose EPN early, and to provide timely medical and surgical intervention for better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Septic Pulmonary Emboli or Pulmonary Metastasis in a Patient with Diabetes Mellitus?

Lee

Chen

et al. 2018

JCM

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Emphysematous pyelonephritis is a rare but life-threatening infection characterized by an accumulation of gas in the renal parenchyma. A high mortality rate was reported, and timely administration of broad-spectrum antibiotics for enteric gram-negative bacilli, such as Escherichia coli, Enterobacter, and Klebsiella pneumoniae, was recommended for improving the clinical outcome. Computed tomography is a useful tool for identifying gas accumulation within the perirenal space. Abdominal ultrasound and abdominal plain film are alternative options with lower accuracy rates. Here, we present the case of a 49-year-old male patient who presented with acute-onset progressive abdominal cramping pain and dysuria. Diffuse bilateral opacities over the lung field and a heterogeneous mass with air density in the abdomen were found on radiological examination. Multiple septic pulmonary emboli and emphysematous pyelonephritis were diagnosed using computed tomography. After emergency percutaneous nephrostomy and administration of broad-spectrum antibiotics, the patient was discharged in a stable condition and followed up at the outpatient department. This report also describes the clinical and imaging features of emphysematous pyelonephritis and highlights that early diagnosis and timely administration of broad-spectrum antibiotics may help avoid a potentially devastating outcome.

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Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis

Cited by 46 publications

References 24 publications

Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis

Septic Pulmonary Emboli or Pulmonary Metastasis in a Patient with Diabetes Mellitus?

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