The Diagnosis and Management of Life-threatening Urologic Infections

Koch, George E.; Johnsen, Niels V.

doi:10.1016/j.urology.2021.05.011

Cited by 7 publications

(8 citation statements)

References 42 publications

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“…The biological assessment shows leukocytosis and sometimes thrombocytopenia, elevated creatinine levels. Cytobacteriological examination of the urine reveals pyuria in most cases [1].…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous Pyelonephritis and Emphysematous Osteomyelitis: A case report

Sninate¹,

Oubaddi²,

Allioui³

et al. 2022

Galician med. j.

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Background. Emphysematous osteomyelitis and emphysematous pyelonephritis are both rare entities responsible for a high death rate. The first is defined by the presence of intravertebral or intraosseous gas, while the second is infectious damage to the renal parenchyma and perilesional tissues caused by gas-producing microorganisms and is, therefore, characterized by the formation of gas. Imaging plays a crucial role in making a rapid diagnosis and, thus, the initiation of the necessary treatment. Case Report. A 66-year-old woman with a medical history of type 2 diabetes mellitus and hypertension presented with the altered general condition and flank pain for 5 days, associated with fever and chills. The patient’s vital signs were remarkable with a disturbed biological workup, which led to emergency abdominal and pelvic computed tomography scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Conclusions. The coexistence of emphysematous pyelonephritis and emphysematous osteomyelitis is a rare life-threatening entity, occurring in patients with comorbidities such as diabetes mellitus. Computed tomography is currently the gold standard in making the positive diagnosis, staging, for a quick and better management and, thus, a favorable prognosis.

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“…The biological assessment shows leukocytosis and sometimes thrombocytopenia, elevated creatinine levels. Cytobacteriological examination of the urine reveals pyuria in most cases [1].…”

Section: Discussionmentioning

confidence: 99%

“…Emphysematous pyelonephritis (EPN) is a necrotizing, gasforming infection of the renal parenchyma and perirenal tissue [1]. The recent mortality rate from EPN is 25% [2].…”

Section: Introductionmentioning

confidence: 99%

Emphysematous Pyelonephritis and Emphysematous Osteomyelitis: A case report

Sninate¹,

Oubaddi²,

Allioui³

et al. 2022

Galician med. j.

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“…The most common pathogens associated with EPN occurrence are facultative anaerobes. Among these bacteria, Escherichia coli is the mostly commonly isolated pathogen (49%–67%), followed by Klebsiella (20%–24%), Proteus (5%–18%), Enterococcus (14%), and Pseudomonas (5%) [ 9 ]. In relatively rare cases, Candida species have been detected, including Candida albicans, Candida parapsilosis , and Candida tropicalis [ 20 21 22 ].…”

Section: P Athophysiologymentioning

confidence: 99%

“…EPN is a life threatening disease, with reported mortality rates ranging from 40% to 90% [ 7 8 ]. EPN treatment options have evolved over time, ranging from aggressive operations to more conservative therapy approaches consisting primarily of drainage and medication [ 9 ]. We provide an evidence-based review of the clinical presentation, diagnosis, treatment modalities, risk factors, and prognostic factors associated with EPN for use as a reliable resource when determining the course of care.…”

Section: Introductionmentioning

confidence: 99%

Emphysematous pyelonephritis

Hsu

Yang

et al. 2022

Tzu Chi Medical Journal

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A BSTRACT Urinary tract infections are commonly encountered and managed worldwide, and emphysematous pyelonephritis (EPN) is among the most serious types of urinary tract infections. EPN is an acute necrotizing infection of the kidney, often associated with high rates of renal loss and mortality. The symptoms of EPN infection can be nonspecific, but the clinical triad of fever, flank pain, and nausea represent the most common presentations. The diagnosis and classification are performed with the assistance of computed tomography (CT). The imaging-based classification system created by Huang and Tseng is widely used in clinical assessments. They defined EPN into four different class (1–4), with the higher number the more severe disease. Optimal EPN treatment is controversial, with emergent nephrectomy suggested during early studies, whereas more recent evidence favors more conservative approaches. Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are most common pathogens. The initial use of broad-spectrum antibiotics such as Third-or fourth-generation cephalosporins and carbapenems are recommended. Diabetes, obstructive uropathy and hypertension are the most common risk factors and often need treatment together. Emergent drainage is indicated with a larger-sized drainage tube to achieve better drainage function. CT guidance has a better success rate than insertion under the guidance of ultrasonography. Nephrectomy should be reserved as the last resort for those who fail to respond to conservative therapy. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of this life-threatening urological infection.

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“…EUTI is typically observed in older women (60–70 years old), with DM being the most notable risk factor for this condition, 1 , 2 while acute renal function impairment, proteinuria, changes in mental status and shock are related to poor prognosis. 3 , 4 , 5 , 6 , 7 The infection is caused by various bacteria, with Escherichia coli being the most prevalent (more than half of the described cases) in urine cultures. The presence of gas‐forming bacteria with high glucose levels in the urinary tract and impaired host response are believed to prompt the development of EUTI.…”

Section: Figurementioning

confidence: 99%

Emphysematous cystitis and pyelonephritis leading to a diagnosis of type 2 diabetes in an older patient

Gaud-Luethi

Scheffler

Mendes

2021

Geriatrics Gerontology Int

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EDITOR CASE REPORTSEmphysematous cystitis and pyelonephritis leading to a diagnosis of type 2 diabetes in an older patient Dear Editor, Emphysematous urinary tract infection is rare, while the co-occurrence of emphysematous pyelonephritis is even more exceptional. We report a case of an older patient without regular medical follow-up presenting with a combination of emphysematous cystitis and pyelonephritis that led to a diagnosis of underlying type 2 diabetes mellitus (DM).An 88-year-old man was admitted to the emergency unit of our hospital with delirium and shivering. His past medical history was unremarkable. On examination, the patient was confused, hemodynamically stable and not febrile. He exhibited bilateral pitting oedema up to the thighs, decreased cardiac sounds and breathing sounds at lung bases. There was also a suprapubic tenderness with dullness on percussion. An enlarged prostate without exacerbated pain on touch was found during the rectal exam. The rest of the examination was unremarkable. Blood analysis at hospital admission showed a non-fasting blood sugar level of 8.4 mmoL/L, a normochromic, normocytic anaemia (Hb 130 mg/ L), no leucocytosis and an elevated C-reactive protein level of 17.6 mg/L. Levels of creatinine and urea were also elevated up to 411 μmol/L and 33 mmoL/L, respectively. eGFR was 10 mL/ min/1.73 m 2 , and the total amount of carbon dioxide was 17.4 mmoL/L. Urine analysis showed a leucocyturia (7537 leucocyte/ mm 3 ) associated with a non-glomerular haematuria (481 red cells/ mm 3 ). An ultrasound scan showed the presence of air in the bladder. Therefore, a non-contrast computed tomography (CT) scan was performed, which revealed extensive intramural air in the bladder wall progressing up to the left kidney with a dilated left ureter and perinephric infiltration (Fig. 1). The bladder was partially filled up with fluid. This was suggestive of emphysematous cystitis and pyelonephritis. The urologist's opinion was that there was no indication to perform drainage with nephrostomy as diuresis was preserved. In order to monitor the urine output and to treat the urinary retention, a perurethral 16 Fr Folley catheter was inserted. Purulent urine was drained after catheterization. Ciprofloxacin was started immediately and was rapidly switched to imipenem for 10 days following results of the urine culture collected at hospital admission and positive within the first 24 h for growth of an extended-spectrum beta-lactamase producing Escherichia coli. The two sets of blood cultures collected were negative. The patient was then moved to the intensive care unit for monitoring. This conservative treatment was successful, with clinical improvement and regression of the radiological diagnoses on follow-up CT. A trial without catheter was unsuccessful, with recurrence of urine retention, leading to long-term catheterization. Subsequently, type 2 diabetes mellitus was confirmed with a glycated hemoglobin level of 8.4%, associated with micro-and macrovascular complications. The patient was later di...

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The Diagnosis and Management of Life-threatening Urologic Infections

Cited by 7 publications

References 42 publications

Emphysematous Pyelonephritis and Emphysematous Osteomyelitis: A case report

Emphysematous Pyelonephritis and Emphysematous Osteomyelitis: A case report

Emphysematous pyelonephritis

Emphysematous cystitis and pyelonephritis leading to a diagnosis of type 2 diabetes in an older patient

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