Emphysematous Urinary Tract Infections: Diagnosis, Treatment and Survival (Case Review Series)
ABSTRACT Emphysematous urinary tract infections are rare conditions, usually occurring in diabetic patients. Mortality rates in medically managed patients are reported to be as high as 70% to 90%. Growth of the diabetic population warrants heightened attention to these potentially fatal infections. We report a series of 5 cases with favorable outcomes.
All patients were diabetic. Presenting symptoms included fever, chills, nausea, vomiting, and abdominal pain. On physical examination, two patients had costovertebral angle tenderness; a third was dehydrated; a fourth had dehydration and an abdominal mass; and a fifth patient had suprapubic tenderness. All cases had leukocytosis and impaired renal function. Computed tomography (CT) scan disclosed emphysematous pyelonephritis in 3 cases (gas within renal parenchyma and/or perirenal tissue), emphysematous pyelitis in 1 case (gas in collecting system), and emphysematous cystitis in 1 patient (gas within bladder wall). Urine culture of 1 case grew Enterococci, whereas in the other cases cultures yielded gas-producing organisms. All patients received intravenous antibiotics. Two patients underwent CT-guided abscess drainage; 2 cases had J-stent placement, and one patient was readmitted with septic shock and underwent nephrectomy. All the patients' conditions improved and they were discharged.
Emphysematous urinary tract infections are usually caused by gas-producing organisms. They should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is the method of choice for diagnosis and follow up. None of our patients died, mainly due to early diagnosis, sequential radiologic assessment, and timely surgical intervention when needed.
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- "In most cases, EC therapy requirs a prolonged course of antibiotics (3 to 6 weeks) with broad-spectrum antibiotics . According to a suggested algorithm shown in a systematic review by Mokabberi R and Ravakhah K , antibiotic treatment alone for 1–2 days is recommended for the initiation of the treatment. However, particularly in patients with urinary retention or neurogenic bladder, continuous catheter drainage is effective . "
ABSTRACT: Emphysematous cystitis occurs mostly in diabetics with poor glycemic control or in immunocompromised patients. In most cases, diabetes mellitus correlates with the occurrence of emphysematous cystitis. The risk of relapse after tuberculosis cure or treatment completion is high among patients with diabetes mellitus. A 64-year-old diabetic man suffering from high fever and lower abdominal pain was admitted to the emergency ward. Due to the results of radiographic examinations, he was diagnosed with an emphysematous cystitis. Although the emphysematous cystitis improved with urinary drainage and antibiotic therapy, the high fever recurred and respiratory symptoms appeared. This patient was diagnosed with a crisis of the pulmonary tuberculosis. He was started on the antituberculosis therapy, and he recovered. This is the first report of a case of emphysematous cystitis that was complicated with pulmonary tuberculosis.American Journal of Case Reports 09/2012; 13:234-7. DOI:10.12659/AJCR.883449
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ABSTRACT: Antecedentes y objetivos: la localizacion de la infeccion urinaria en el nino tiene implicaciones terapeuticas y pronosticas. La afectacion gammagrafica se considera como �ápatron oro�â en el diagnostico de pielonefritis aguda. Se han realizado estudios con biomarcadores urinarios con resultados controvertidos. El objetivo de este estudio ha sido determinar la utilidad de �À2-microglobulina, �¿1-microglobulina, cistatina C, IgG y albumina en el diagnostico de localizacion, analizando la relacion entre su excrecion urinaria, parametros clinicos y de laboratorio y la afectacion renal gammagrafica. Pacientes y metodos: estudio observacional prospectivo realizado en 40 pacientes de un mes a 11 anos de edad tras su ingreso hospitalario por sospecha de pielonefritis. Se analizaron variables clinicas y de laboratorio, realizando una ecografia renal y una gammagrafia renal en los primeros siete dias del ingreso. Una vez remitida la fiebre, se analizo el cociente urinario proteina/creatinina para cada variable. Tras el proceso agudo, se realizo una gammagrafia renal en fase tardia para detectar cicatrices renales. Resultados: el filtrado glomerular y la ecografia fueron normales en todos los pacientes. Un 45% de los ninos (24/80 rinones) tuvieron alteraciones gammagraficas compatibles con pielonefritis aguda, no existiendo diferencias en la proteinuria entre estos y aquellos con gammagrafia normal. A mayor edad, mayor probabilidad de afectacion gammagrafica. La sensibilidad y especificidad de los leucocitos y PCR para predecir pielonefritis fue del 77-65 y 94-52%, r = 0,70 (IC 95% 0,54-0,87) y 0,75 (IC 95% 0,60-0,90), respectivamente. No existe relación entre la temperatura máxima o duración de los síntomas y la afectación renal. Conclusiones: la gammagrafía renal sigue siendo el patrón de referencia en el diagnóstico de pielonefritis aguda en Pediatría. El uso combinado con marcadores urinarios de función renal no aumenta su sensibilidad. Es preciso realizar estudios que confirmen la utilidad de nuevos biomarcadores.Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 01/2009; 29(2). · 1.22 Impact Factor
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ABSTRACT: Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. It is a rare condition, usually occurring in diabetic patients. Mortality rates in medically managed patients are as high as 70–90 %. It should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is diagnostic and is the method of choice for diagnosis and follow-up. Both physicians and surgeons should be aware of this rare condition which might present to the physician as fulminant urinary tract infection in an uncontrolled diabetic patient, but which might warrant urgent surgical intervention by way of an emergency nephrectomy. We report a 60-year-old diabetic woman who presented with urinary infection and sepsis. Initially she was managed conservatively, but had to be taken up for emergency nephrectomy in view of her worsening condition. We review the clinical presentation, radiological diagnosis with characteristic CT scan pictures, and the management of this rare condition.Indian Journal of Surgery 06/2013; 75(1). DOI:10.1007/s12262-012-0690-6 · 0.26 Impact Factor