Emphysematous Urinary Tract Infections: Diagnosis, Treatment and Survival (Case Review Series)

Department of Medicine, Huron Hospital, a Cleveland Clinic Hospital, Cleveland, Ohio 44112, USA.
The American Journal of the Medical Sciences (Impact Factor: 1.39). 03/2007; 333(2):111-6. DOI: 10.1097/00000441-200702000-00009
Source: PubMed


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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    • "The prognosis of EC is generally good with an improvement of the patient's condition within the first week. Complications are noted in 10–20% and the mortality rate is low (7%) [1] [5] [6]. "
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    ABSTRACT: Emphysematous cystitis (EC) is a rare, rapidly progressive infection characterized by gas formation within the bladder wall. Gas production is mainly due to fermentation of glucose or albumin by the pathogenic organisms. We present the case of a patient with EC who presented with severe sepsis of unknown origin. He was also found to have two vesical calculi and a horseshoe kidney. EC was diagnosed on ultrasonography which showed circumferential, acoustic shadowing around the bladder wall. Computed tomography (CT) confirmed the diagnosis. Rapid healing could be achieved with appropriate antibiotics and bladder drainage. Endoscopic disintegration of the stones was performed three weeks later, and follow-up was uneventful.
    Full-text · Article · Jan 2015 · African Journal of Urology
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    • "In most cases, EC therapy requirs a prolonged course of antibiotics (3 to 6 weeks) with broad-spectrum antibiotics [12]. According to a suggested algorithm shown in a systematic review by Mokabberi R and Ravakhah K [13], 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 [9]. "
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    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.
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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.
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