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Nelson Z, Tarik Aslan A, Beahm NP, Blyth M, Cappiello M, Casaus D, Dominguez F, Egbert S, Hanretty A, Khadem T, Olney K, Abdul-Azim A, Aggrey G, Anderson DT, Barosa M, Bosco M, Chahine EB, Chowdhury S, Christensen A, de Lima Corvino D, Fitzpatrick M, Fleece M, Footer B, Fox E, Ghanem B, Hamilton F, Hayes J, Jegorovic B, Jent P, Jimenez-Juarez RN, Joseph A, Kang M, Kludjian G, Kurz S, Lee RA, Lee TC, Li T, Maraolo AE, Maximos M, McDonald EG, Mehta D, Moore JW, Nguyen CT, Papan C, Ravindra A, Spellberg B, Taylor R, Thumann A, Tong SYC, Veve M, Wilson J, Yassin A, Zafonte V, Mena Lora AJ. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2024; 7:e2444495. [PMID: 39495518 DOI: 10.1001/jamanetworkopen.2024.44495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2024] Open
Abstract
Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. Objective To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength. Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches. Findings A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation. Conclusions and Relevance In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
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Affiliation(s)
- Zachary Nelson
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | - Abdullah Tarik Aslan
- The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Susan Egbert
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Tina Khadem
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katie Olney
- University of Kentucky Healthcare, Lexington
| | - Ahmed Abdul-Azim
- Rutgers Health Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | - Mariana Barosa
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | | | - Alyssa Christensen
- HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota
| | | | | | | | | | - Emily Fox
- UT Southwestern MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Boris Jegorovic
- Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorovic", Belgrade, Serbia
| | - Philipp Jent
- Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Annie Joseph
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Minji Kang
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Sarah Kurz
- University of Michigan Medical School, Ann Arbor
| | | | - Todd C Lee
- McGill University, Montreal, Quebec, Canada
| | - Timothy Li
- The Chinese University of Hong Kong, Hong Kong, China
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Italy
| | - Mira Maximos
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | | | - Dhara Mehta
- Bellevue Hospital Center, Manhattan, New York, New York
| | | | | | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | | | - Brad Spellberg
- Los Angeles General Medical Center, Los Angeles, California
| | - Robert Taylor
- Newfoundland and Labrador Health Services, St John's, Newfoundland & Labrador, Canada
- Memorial University, St. John's, Newfoundland & Labrador, Canada
| | | | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michael Veve
- Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - James Wilson
- Rush University Medical Center, Chicago, Illinois
| | - Arsheena Yassin
- Rutgers Health Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Liu JD, VanTreeck KE, Marston WA, Papadopoulou V, Rowe SE. Ultrasound-Mediated Antibiotic Delivery to In Vivo Biofilm Infections: A Review. Chembiochem 2024; 25:e202400181. [PMID: 38924307 PMCID: PMC11483220 DOI: 10.1002/cbic.202400181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 06/28/2024]
Abstract
Bacterial biofilms are a significant concern in various medical contexts due to their resilience to our immune system as well as antibiotic therapy. Biofilms often require surgical removal and frequently lead to recurrent or chronic infections. Therefore, there is an urgent need for improved strategies to treat biofilm infections. Ultrasound-mediated drug delivery is a technique that combines ultrasound application, often with the administration of acoustically-active agents, to enhance drug delivery to specific target tissues or cells within the body. This method involves using ultrasound waves to assist in the transportation or activation of medications, improving their penetration, distribution, and efficacy at the desired site. The advantages of ultrasound-mediated drug delivery include targeted and localized delivery, reduced systemic side effects, and improved efficacy of the drug at lower doses. This review scrutinizes recent advances in the application of ultrasound-mediated drug delivery for treating biofilm infections, focusing on in vivo studies. We examine the strengths and limitations of this technology in the context of wound infections, device-associated infections, lung infections and abscesses, and discuss current gaps in knowledge and clinical translation considerations.
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Affiliation(s)
- Jamie D. Liu
- Department of Microbiology and Immunology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Kelly E. VanTreeck
- Joint Department of Biomedical Engineering, The University of North Carolina and North Carolina State University, Chapel Hill, North Carolina 27599, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - William A. Marston
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Virginie Papadopoulou
- Joint Department of Biomedical Engineering, The University of North Carolina and North Carolina State University, Chapel Hill, North Carolina 27599, USA
- Department of Radiology, The University of North Carolina at Chapel Hill, NC, USA
| | - Sarah E. Rowe
- Department of Microbiology and Immunology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599, USA
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3
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Juell CB, Harp TB, Eberly MD. Citrobacter koseri Renal Abscess in an Adolescent. Pediatr Infect Dis J 2024; 43:e377. [PMID: 38808974 DOI: 10.1097/inf.0000000000004405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Colton B Juell
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tyler B Harp
- Division of General Pediatrics, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Matthew D Eberly
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
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Johnson C, Lapsley J, Piegols H, Byron J, Green E, Selmic LE. Diagnosis and successful medical management of a renal corticomedullary abscess in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:900-905. [PMID: 39219608 PMCID: PMC11339903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
A 10-year-old spayed female mixed-breed dog was brought to the Ohio State University Veterinary Medical Center because of a suspected mass located to the right kidney. The mass was diagnosed by abdominal ultrasound following a recurrent lower urinary tract infection. Abdominal computed tomography revealed 2 isoattenuating, peripherally hypoattenuating, and centrally non-contrast-enhancing nodules in the right kidney; the larger one measured 1.9 cm. Initial attempts at fine-needle aspiration were unsuccessful. The dog was returned and the mass was aspirated using ultrasound guidance under heavy sedation. Cytology confirmed the presence of septic inflammation, consistent with a renal corticomedullary abscess. The dog was administered oral enrofloxacin (15 mg/kg, q24h) after diagnosis. Ultrasound guidance was used 2 wk later, under general anesthesia, to achieve percutaneous drainage of ~0.25 mL of fluid and instillation of 5.7 mg (0.25 mL) of enrofloxacin into the abscess capsule. Two weeks after percutaneous drainage, ultrasound examination showed complete resolution of the renal corticomedullary abscess. Urine culture confirmed resolution of the urinary tract infection. To the authors' knowledge, kidney-sparing medical management has never been successfully reported in a dog with a renal corticomedullary abscess. Key clinical message: Renal corticomedullary abscesses occur infrequently in dogs. Medical management is feasible and can result in complete resolution of clinical signs and imaging abnormalities.
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Affiliation(s)
- Carley Johnson
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
| | - Janis Lapsley
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
| | - Hunter Piegols
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
| | - Julie Byron
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
| | - Eric Green
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 1900 Coffey Road, Columbus, Ohio 43210, USA
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Tokuchi M, Yonishi H, Namba-Hamano T. Successful treatment of a renal allograft abscess with antimicrobial agents alone and appropriate follow-up imaging. Transpl Infect Dis 2024; 26:e14278. [PMID: 38584595 DOI: 10.1111/tid.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
A renal allograft abscess is a relatively rare condition. Appropriate antimicrobial therapy and drainage are recommended for treating renal abscesses. However, drainage can be challenging, depending on the location of the abscess. We present the case of a young female kidney transplant recipient who was successfully cured of a renal allograft abscess, using antimicrobial agents and appropriate follow-up imaging, without the need of any risky procedures.
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Affiliation(s)
- Maho Tokuchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Yonishi
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoko Namba-Hamano
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
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6
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Wojtas A, Kunitsky KD, Cavayero C, Salami A. Renal Abscess Drainage Using a Novel Transgastric Endoscopic Approach: A Case Report. Cureus 2023; 15:e51294. [PMID: 38283446 PMCID: PMC10822679 DOI: 10.7759/cureus.51294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Renal and perinephric abscesses are rare purulent infections within or around renal parenchyma, typically treated with antibiotics or various procedural approaches depending on abscess size. In this case report, we describe the novel use of a transgastric endoscopic ultrasound (EUS)-guided technique with placement of a stent for drainage between a renal abscess and the stomach in a patient who had failed attempted percutaneous drainage twice and where an open surgical approach was deemed inappropriate. The patient presented with a chief complaint of left flank pain, with CT revealing a ~4 x 4 cm renal abscess in the upper pole of the left kidney. Urology, Infectious Disease, and Interventional Radiology were consulted. Following two failed attempts at percutaneous drain placement, the patient elected for EUS-guided transgastric stent placement for drainage. The stent was removed by postoperative day two after significant decompression of the abscess. He was advised to follow up outpatient with Urology to confirm full renal abscess resolution.
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Affiliation(s)
- Abby Wojtas
- Department of Gastroenterology, Kansas City University, Kansas City, USA
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Lizana N, Parrao D, Larrañaga M, Figueroa‐Vercellino JP, Pozo K, Bravo JC. Endogenous endophthalmitis secondary to perirenal abscess. IJU Case Rep 2023; 6:271-273. [PMID: 37667766 PMCID: PMC10475336 DOI: 10.1002/iju5.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/09/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Endogenous Endophthalmitis is a rare ocular infection but with poor visual prognosis for most patients. Its most frequent etiology is Klebsiella spp., associated with hepatic abscesses and less frequently with perirenal abscesses. Case presentation We present a 61-year-old woman with a history of poorly controlled diabetes mellitus 2 that consulted several times for acute pyelonephritis with torpid evolution, associated with endogenous endophthalmitis in her right eye that required evisceration. Conclusion Adequate management of acute pyelonephritis can avoid local or distant complications, such as endogenous endophthalmitis, an infection with poor visual prognosis that requires high clinical suspicion for timely management with better visual outcomes and lower morbimortality.
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Affiliation(s)
| | - Diego Parrao
- Medicine SchoolUniversidad de O'HigginsRancaguaChile
| | - Matías Larrañaga
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
| | | | - Karen Pozo
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
| | - Juan Cristóbal Bravo
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
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8
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Phongphithakchai A, Konwai S, Kanchanasuwan S, Hongsakul K. A Rare Case of Bilateral Renal Abscess from Staphylococcal Infection in a Young Healthy Patient. Indian J Nephrol 2023; 33:304-306. [PMID: 37781555 PMCID: PMC10503570 DOI: 10.4103/ijn.ijn_178_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/06/2022] [Accepted: 07/22/2022] [Indexed: 10/03/2023] Open
Abstract
Bilateral renal abscess is a rare infectious disease. Most patients have some risk factors for comorbidities, such as diabetes or an abnormal urinary tract, causing abscess formation. The incidence of the disease is infrequent in young healthy adults. Here, we report a case of a previously healthy non-diabetic young man who presented with abdominal pain with a high-grade fever. With clinically persistent abdominal pain, computerized tomography of the whole abdomen was done. The result showed bilateral renal abscess. The culture from the abscess reported Staphylococcus aureus. The patient's clinical abdominal pain and fever resolved after receiving antibiotics for 4 weeks.
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Affiliation(s)
- Atthaphong Phongphithakchai
- Division of Nephrology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sirihatai Konwai
- Division of Nephrology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siripen Kanchanasuwan
- Division of Infectious Diseases, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Chaurasia A, Singh S, Homayounieh F, Gopal N, Jones EC, Linehan WM, Shyn PB, Ball MW, Malayeri AA. Complications after Nephron-sparing Interventions for Renal Tumors: Imaging Findings and Management. Radiographics 2023; 43:e220196. [PMID: 37384546 PMCID: PMC10323228 DOI: 10.1148/rg.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 07/01/2023]
Abstract
The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
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Affiliation(s)
- Aditi Chaurasia
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Shiva Singh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Fatemeh Homayounieh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Nikhil Gopal
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Elizabeth C. Jones
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - W. Marston Linehan
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Paul B. Shyn
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Mark W. Ball
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Ashkan A. Malayeri
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
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10
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Ding JG, Zhang G, Wang Y. Successful eradication of renal allograft abscess by CT-guided percutaneous pigtail drainage: A case report. Medicine (Baltimore) 2023; 102:e33551. [PMID: 37058038 PMCID: PMC10101242 DOI: 10.1097/md.0000000000033551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
RATIONALE Renal allograft abscess is an infrequent complication in kidney transplant recipients. The mainstay of treatment is adequate drainage and optimal antibiotic administration. PATIENT CONCERNS A 25-year-old female who presented with dysuria, frequency, chills, fever, and allograft pain was initially diagnosed with a urinary tract infection complicated by septic shock 15 months after kidney transplantation. Ultrasound depicted a hypoechoic mass and contrast-enhanced computed tomography (CT) revealed a lesion with no enhancement in the renal allograft. CT-guided percutaneous pigtail drainage placement was implemented. DIAGNOSES Blood-stained pus was aspirated from the lesion in the renal allograft. The aspirate culture revealed Escherichia coli and Proteus mirabilis with an antibiogram consistent to urine culture. The diagnosis of renal allograft abscess originated from urinary tract infection was confirmed. INTERVENTIONS The patient underwent CT-guided percutaneous pigtail drainage and conducted culture of the aspirate. OUTCOMES The patient's symptoms immediately abated after drainage and renal allograft function recovered normally. Ultrasound and CT showed total regression of the renal allograft abscess at the 1-month outpatient follow-up. LESSONS Heightened alertness should be attached to that severe urinary tract infections presenting with sepsis shock and antibiotic treatment non responders are likely to progress to renal allograft abscess in kidney transplant recipients. CT-guided percutaneous pigtail drainage was a safe and effective minimally invasive treatment.
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Affiliation(s)
- Jing Gang Ding
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
| | - Ge Zhang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
| | - YuHui Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
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Trainor-Moss S, Acquah RR, Peirse M, Beadles W. Renal abscess with Capnocytophaga canimorsus infection from a dog bite. BMJ Case Rep 2022; 15:e250447. [PMID: 36593617 PMCID: PMC9743273 DOI: 10.1136/bcr-2022-250447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
We present a case of renal abscess caused by Capnocytophaga canimorsus infection in a previously healthy middle-aged man. He presented with sepsis and an acute kidney injury, and although not identified on his initial assessment, he had sustained a dog bite 5 days prior to hospital admission. The patient developed left loin pain and imaging investigation revealed a renal abscess. Gram stain showed a gram-negative bacillus and C. canimorsus was identified by 16S PCR from these samples along with aspirate from the abscess. The patient responded to treatment with carbapenems but required a prolonged course. His clinical condition was further complicated by a pleural effusion and the development of fatigue symptoms consistent with a post-infection chronic fatigue syndrome. We present this case which we believe to be the first documented case of C. canimorsus causing renal abscess. We discuss the challenges relating to investigation, management and the importance of detailed diagnostic exposure histories in sepsis of unknown origin.
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Affiliation(s)
| | | | - Mary Peirse
- Infectious Diseases Department, Raigmore Hospital, Inverness, UK
| | - Wendy Beadles
- Infectious Diseases Department, Raigmore Hospital, Inverness, UK
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12
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Buschel H, Leung P, Stalewski H, Carroll D, Mariyappa-Rathnamma B. Renal abscesses in children: an 11-year retrospective study and review of the literature. ANZ J Surg 2022; 92:3293-3297. [PMID: 35877550 DOI: 10.1111/ans.17943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/29/2022] [Accepted: 07/15/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is limited literature on renal abscesses in children and therefore no consensus on management. The objectives of this study were to describe renal abscesses in a contemporary paediatric Australian population and present a 20 year review of the literature. METHODS An 11 year retrospective comparative study was conducted of paediatric patients with renal abscesses. A literature review of all eight original articles on paediatric renal abscesses from January 2001 to December 2021 was performed. RESULTS Fourteen children with a mean age of 11 years were diagnosed with a renal abscess on ultrasound and/or computed tomography. The most common presenting symptoms were fever (n = 13, 93%) and flank or abdominal pain (n = 12, 86%). The most common causative organisms were Staphylococcus aureus (n = 7, 50%) and Escherichia coli (n = 4, 29%). All renal abscesses less than 3 cm were managed with antibiotics alone. Five out of nine abscesses 3-5 cm were managed with percutaenous drainage (56%). Two multi-loculated abscesses greater than 5 cm required open drainage in theatre (100%). CONCLUSIONS The most common causative organism in the North Queensland population was S. aureus, with a higher incidence of MRSA. This should be taken into consideration when prescribing empirical antibiotics. Most renal abscesses in children that are less than 3 cm in size can be managed with antibiotic therapy only. The evidence for management of larger abscesses is less clear, but where clinically appropriate conservative management with antibiotic therapy should be considered in the first instance, with percutaneous drainage in cases of antibiotic failure.
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Affiliation(s)
- Helen Buschel
- Department of Health and Well-being/Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Phoebe Leung
- Department of Health and Well-being/Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Harry Stalewski
- Department of Health and Well-being/Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Daniel Carroll
- Department of Health and Well-being/Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Bhanu Mariyappa-Rathnamma
- Department of Health and Well-being/Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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13
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Hua DT, Lo J, Do HQ, Pham CD. A case of Citrobacter koseri renal abscess and review of the literature. SAGE Open Med Case Rep 2022; 10:2050313X221135347. [PMID: 36337163 PMCID: PMC9630887 DOI: 10.1177/2050313x221135347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
Citrobacter species are anaerobic gram-negative bacteria that are known to cause infections in immunocompromised hosts, particularly in hospital settings. Their opportunistic nature and tendency to develop antibiotic resistance make Citrobacter species challenging to treat. Renal or perinephric abscess formation as a result of Citrobacter infection is uncommon, having only previously been reported in four cases. We present a case of a 70-year-old man with diabetes and prostate cancer who was diagnosed with an 18 cm perinephric and a 10 cm perihepatic abscess caused by Citrobacter koseri. The patient required drains and re-positioning of the drains multiple times in addition to a prolonged course of antibiotics to achieve complete radiographic resolution. This case highlights the challenges in treating renal and perinephric abscess, as it required drain re-placements two additional times after the initial placement and an additional 4 weeks of antibiotics. Successful treatment for larger abscesses usually requires a two-arm approach, with antibiotics in combination with either percutaneous or surgical abscess drainage.
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Affiliation(s)
- Duong Tommy Hua
- Duong Tommy Hua, Department of Internal
Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA
90502, USA.
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14
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Jain P, Prasad A, Sharma R, Jain S. Renal abscess in children: Is size an important determinant in deciding treatment options? JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221084821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children. Objective: In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm. Study design: This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome. Results: Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention. Conclusion: A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention. Level of evidence: 4
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Affiliation(s)
- Prashant Jain
- Department of Paediatric Surgery and Paediatric Urology, BLK-MAX Super Speciality Hospital, New Delhi, India
| | - Ashish Prasad
- Department of Paediatric Surgery and Paediatric Urology, BLK-MAX Super Speciality Hospital, New Delhi, India
| | - Rachna Sharma
- Department of Paediatric Intensive care, BLK-MAX Super Speciality Hospital, New Delhi, India
| | - Sarika Jain
- Department of Radiodiagnosis, DODA Imaging, New Delhi, India
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15
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CT-guided percutaneous drainage of abdominopelvic collections: a pictorial essay. Radiol Med 2021; 126:1561-1570. [PMID: 34415507 PMCID: PMC8702416 DOI: 10.1007/s11547-021-01406-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/28/2021] [Indexed: 11/06/2022]
Abstract
CT-guided percutaneous drainage is a safe and effective procedure that allows minimally invasive treatment of abdominopelvic abscesses and fluid collections. This technique has become an alternative for surgery with lower morbility and mortality rates. In this pictorial essay, we aim at providing an overview of the technical approaches, the main clinical indications and complications of CT-guided percutaneous drainage, in order to provide a practical guide for interventional radiologists, with a review of the recent literature. The focus will be the CT-guidance, preferred when the interposition of viscera, vascular and skeletal structures, counteracts the ultrasound guidance.
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16
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Long V, Soon YH, Soo MRT, Tan LF. Concomitant xanthogranulomatous pyelonephritis with renal abscess - an unusual cause of a right flank mass. Int Braz J Urol 2021; 47:1069-1071. [PMID: 34260186 PMCID: PMC8321458 DOI: 10.1590/s1677-5538.ibju.2020.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Valencia Long
- Fast Program, Alexandra Hospital, National University Hospital System, Singapore
| | - Young Hwa Soon
- Fast Program, Alexandra Hospital, National University Hospital System, Singapore
| | | | - Li Feng Tan
- Division of Healthy Ageing, National University Hospital System, Alexandra Hospital, Singapore
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17
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Nozaki Y, Ono D, Yamamoto K, Mimura K, Sasaki M, Horino A, Ohno H, Oka H. A case of renal abscess and bacteremia caused by Burkholderia pseudomallei that was first unidentifiable by matrix-assisted laser desorption ionization-time of flight mass spectrometry in a Japanese-man. J Infect Chemother 2021; 27:1653-1657. [PMID: 34147356 DOI: 10.1016/j.jiac.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in specific regions, including Southeast Asia and Northern Australia. In Japan, where no autochthonous has been reported to date, melioidosis is a rare infectious disease. Herein, we report a case of melioidosis in a 68-year-old Japanese man with renal abscess and bacteremia, but without pneumonia. The patient presented to our hospital and was admitted for fever and chills that have persisted for two months. It was speculated that he was infected in Thailand, where his family lives because he shuttled between Thailand and Japan. Blood cultures on admission identified Burkholderia species; however, the species was unidentifiable by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Further re-examination, including culture, loop-mediated isothermal amplification, and multiplex polymerase chain reaction methods, finally identified Burkholderia pseudomallei. We treated the patient with intravenous ceftazidime for four weeks. In addition to the antibiotics administration, puncture drainage of the renal abscess was performed, and he gradually became afebrile. Intravenous ceftazidime was switched to oral sulfamethoxazole/trimethoprim on post-admission day 32, and he was discharged. After five months of oral sulfamethoxazole/trimethoprim, no recurrence was observed one year after discharge. To diagnose melioidosis, especially in non-endemic areas, a precise and thorough understanding of its epidemiology, presentation, and identification methods is necessary.
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Affiliation(s)
- Yujin Nozaki
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Daisuke Ono
- Department of Infectious Diseases and Infection Control, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - Kei Yamamoto
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuyuki Mimura
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masakazu Sasaki
- Department of Clinical Laboratories, Toho University Omori Medical Center, Tokyo, Japan
| | - Atsuko Horino
- Department of Bacteriology II, National Institute of Infectious Diseases, Japan
| | - Hideaki Ohno
- Department of Infectious Diseases and Infection Control, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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18
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İnözü M, Bajin İY, Aydın Z, Aksoy ÖY, Güneş A, Yaralı HN, Bayrakçı US. Macroscopic hematuria in a patient with leukemia: Answers. Pediatr Nephrol 2021; 36:1455-1456. [PMID: 33001298 DOI: 10.1007/s00467-020-04778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mihriban İnözü
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey.
| | - İnci Yaman Bajin
- Department of Pediatric Hematology, Ankara City Hospital, Ankara, Turkey
| | - Zehra Aydın
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
| | - Özlem Yüksel Aksoy
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
| | - Altan Güneş
- Department of Pediatric Radiology, Ankara City Hospital, Ankara, Turkey
| | | | - Umut Selda Bayrakçı
- Department of Pediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, 06800, Çankaya/Ankara, Turkey
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19
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Imaging of abdominal and pelvic infections in the cancer patient. Abdom Radiol (NY) 2021; 46:2920-2941. [PMID: 33386914 PMCID: PMC7778421 DOI: 10.1007/s00261-020-02896-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/01/2022]
Abstract
Infections are the most commonly encountered complications in patients with cancer. The classical signs and symptoms of infections are often not present in this patient population, which makes the diagnosis more challenging. Host factors play a major role in the development and prognosis of infections in cancer patients; these can be related to the underlying type of malignancy (solid organ versus hematological), tumor burden, anatomic obstruction, altered integrity of barriers (skin or mucosa), treatment-related factors (from chemotherapy, radiation treatment, surgery, interventional procedures, and/or medical device placement) and the degree of immunosuppression. This article reviews common, as well as less common, imaging manifestations of infections and their potential mimics in the abdomen and pelvis in cancer patients and discusses their differentiating features, with the role of imaging in various organs in the abdomen and pelvis taking into consideration relevant clinical background information and the main risk factors.
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20
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Trumm CG, Burgard C, Deger C, Stahl R, Forbrig R, D'Anastasi M. Intermittent quick-check CT fluoroscopy-guided percutaneous drainage placement in patients with infected renal and perirenal fluid collections: 11-year experience. ACTA ACUST UNITED AC 2021; 27:378-385. [PMID: 34003125 DOI: 10.5152/dir.2021.20068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate technical and clinical success and safety of computed tomography fluoroscopy (CTF)-guided percutaneous pigtail drainage (PPD) placement in patients with infected renal and perirenal fluid collections. METHODS This retrospective analysis comprised 44 patients (52.27% men; age, 57.1±18.5 years) undergoing low-milliampere (10-20 mA) CTF-guided PPD placement in 61 sessions under local anesthesia from August 2005 to November 2016. Infected fluid collections (n=71) included infected renal cysts (12.68%), renal and perirenal abscesses due to comorbidities (23.94%), or fluid collections after renal surgery or urological intervention (63.38%). Technical success was defined as PPD placement with consecutive fluid aspiration, clinical success as normalization or marked improvement of clinical symptoms (e.g., flank pain, fever) and inflammatory parameters (leukocyte count, C-reactive protein) after minimally invasive combination therapy (intravenous broad-spectrum antibiotics and drainage). Complications were classified according to the CIRSE classification. RESULTS Overall, 73 single lumen PPD (7.5-12 F) were utilized (1 PPD per session, 69.86%; 2 PPD per session, 15.07%). In 4 cases, PPD could not be inserted into the fluid collection (4.11%) or could not be aspirated (1.37%), yielding overall 94.5% primary technical success. Mean duration of functioning PPD before removal was 10.9 days. Adverse events within 30 days comprised PPD failure (2.27%) or secondary dislocation (Grade 3, 11.36%) and one death (Grade 6, unrelated to intervention, 2.27%). Additional invasive measures after primary CTF-guided PPD were required in 5 patients (nephrectomy 6.82%, partial nephrectomy 2.27%, surgical drainage 2.27%). Thus, clinical success using only minimally invasive measures was achieved in 39 of 44 patients (88.64%). CONCLUSION Given a minor proportion of patients requiring surgical revision, combined antibiotics and CTF-guided PPD of infected renal and perirenal fluid collections provides an excellent technical and clinical outcome.
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Affiliation(s)
- Christoph G Trumm
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Caroline Burgard
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Constanze Deger
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Stahl
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Forbrig
- Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, Triq tal-Qroqq, Msida, Malta
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21
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Is renal abscess still a problem? MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.869032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Norkus CL, Keir I. Successful medical management of perinephric abscess and urosepsis following urethral obstruction in a cat. J Vet Emerg Crit Care (San Antonio) 2020; 30:318-324. [PMID: 32096292 DOI: 10.1111/vec.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/19/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the clinical presentation and medical management of a cat with perinephric abscessation and urosepsis following urethral obstruction and catheterization. CASE SUMMARY A 2-year-old intact male domestic shorthaired cat presented to an emergency and referral center for lethargy, vomiting, and hematuria. Severe azotemia and hyperkalemia were observed on a serum biochemistry panel. The patient was diagnosed with urethral obstruction and was treated with urethral catheterization, calcium gluconate, IV fluid therapy, buprenorphine, and prazosin. The patient's azotemia improved, and the hyperkalemia resolved. Urinary catheterization was discontinued. The patient developed pyrexia, worsening azotemia, hypoalbuminemia, hyperbilirubinemia, and dysuria. Urethral catheterization was repeated. Abdominal radiographs showed left renomegaly, and abdominal ultrasound revealed left perinephric fluid. Ultrasound-guided centesis of the perinephric fluid revealed septic inflammation, and the sample was consistent with urine based upon sample creatinine. Fluid from the perinephric abscess and urine from the bladder both grew Pasturella spp. The patient was treated with perinephric catheterization, saline lavage, and a continuous infusion of cefotaxime for 72 h. The patient's azotemia quickly resolved, and the patient was discharged after 6 days of hospitalization. The patient was reported to have made a full recovery. NEW OR UNIQUE INFORMATION PROVIDED This is the first described case of perinephric abscess and urosepsis following urethral obstruction in a cat and its successful medical management. Perinephric abscess not associated with intrarenal abscess has not previously been identified. Additionally, continuous antimicrobial infusion to treat overwhelming infection and the use of the RapidBac Vet immunoassay for point-of-care detection of urinary tract infection has not been described in cats.
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Affiliation(s)
| | - Iain Keir
- Allegheny Veterinary Emergency Trauma & Specialty, Monroeville, PA
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23
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Perinephric abscess as a rare cause of acute abdomen: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.608975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhang X, Xie Y, Huang G, Fu H. Analysis of 17 children with renal abscess. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:3179-3184. [PMID: 31934162 PMCID: PMC6949854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE This study's aims to analyze the clinical characteristics of children with renal abscess and improve its diagnosis and treatment. METHODS The clinical data of children diagnosed with renal abscess in our hospital from 2007 to 2016 were retrospectively analyzed, including clinical manifestations, laboratory tests, imaging examinations, and treatment measures. RESULTS 17 children with renal abscess were enrolled with median age was 15 (1.5-163) months old. There were 7 girls and 10 boys. Fever was the most common symptom (82.4%). 58.9% of children suffered from abnormal urogenital function before onset, mainly manifested as ureteral abnormalities (41.2%), renal dysplasia, or non-functioning kidneys (17.6%). Acute C-reactive protein and erythrocyte sedimentation rate (ESR) were increased in more than 85% patients, but the elevation of procalcitonin was not significant (10%). 41.2% of the children had anemia, and 64.7% exhibited markedly elevated leukocytosis. All cases were negative by blood culture. The pathogen was mainly Gram-negative bacteria (47.1%), including Escherichia coli. The detection rate of Enterococcus and Candida albicans was 23.5%. Mycobacterium tuberculosis was found in 1 case. B-ultrasound and magnetic resonance imaging were most commonly used. All cases received anti-infective treatment. 10 cases were ineffective and underwent surgical treatment. There was a significant difference in the treatment outcome between abscesses larger and smaller than 4 cm (P < 0.05). CONCLUSION For children with fever, abdominal pain, or flank pain, together with elevated white blood cell count, CRP, ESR, and IL-6, especially when anti-infective effect is poor, renal abscess should be considered. The initial anti-infective treatment of renal abscess can use a step-down scheme. The regimen needs to strengthen the anti-Gram positive bacteria and fungal treatment, and consider the possibility of renal tuberculosis infection. Conservative anti-infective treatment can be used in children with abscess size smaller than 4 cm, while surgery is recommended in abscesses larger than 4 cm not responsive to drug therapy.
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Affiliation(s)
- Xiaojing Zhang
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine Hangzhou 310003, Zhejiang, China
| | - Yi Xie
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine Hangzhou 310003, Zhejiang, China
| | - Guoping Huang
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine Hangzhou 310003, Zhejiang, China
| | - Haidong Fu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine Hangzhou 310003, Zhejiang, China
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25
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Abstract
Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.
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26
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Haidar G, Green M. Intra-abdominal infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13595. [PMID: 31102546 DOI: 10.1111/ctr.13595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
This new guideline from the AST IDCOP reviews intra-abdominal infections (IAIs), which cause substantial morbidity and mortality among abdominal SOT recipients. Each transplant type carries unique risks for IAI, though peritonitis occurs in all abdominal transplant recipients. Biliary infections, bilomas, and intra-abdominal and intrahepatic abscesses are common after liver transplantation and are associated with the type of biliary anastomosis, the presence of vascular thrombosis or ischemia, and biliary leaks or strictures. IAIs after kidney transplantation include renal and perinephric abscesses and graft-site candidiasis, which is uncommon but may require allograft nephrectomy. Among pancreas transplant recipients, duodenal anastomotic leaks can have catastrophic consequences, and polymicrobial abscesses can lead to graft loss and death. Intestinal transplant recipients are at the highest risk for sepsis, infection due to multidrug-resistant organisms, and death from IAI, as the transplanted intestine is a contaminated, highly immunological, pathogen-rich organ. Source control and antibiotics are the cornerstone of the management of IAIs. Empiric antimicrobial regimens should be tailored to local susceptibility patterns and pathogens with which the patient is known to be colonized, with subsequent optimization once the results of cultures are reported.
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Affiliation(s)
- Ghady Haidar
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael Green
- Departments of Pediatrics, Surgery & Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Asymptomatic Bacteriuria in Pregnancy Complicated by Pyelonephritis Requiring Nephrectomy. Case Rep Obstet Gynecol 2018; 2018:8924823. [PMID: 30327737 PMCID: PMC6169228 DOI: 10.1155/2018/8924823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/24/2018] [Indexed: 11/21/2022] Open
Abstract
Routine prenatal care in the United States includes screening for asymptomatic bacteriuria (ASB), which occurs in 2 to 7 percent of pregnant women and can cause urinary tract infection and pyelonephritis. We present the case of a pregnant woman affected by multidrug resistant Klebsiella induced ASB during her prenatal screen, which was untreated due to a repeat urine culture showing mixed flora; subsequently, the patient's postpartum course was complicated by pyelonephritis and perinephric abscess, concluding in a radical nephrectomy. Current recommendations are to treat ASB after two consecutive voided urine cultures showing the same bacterial strain in quantitative counts of =/> 10(5) colony forming units (cfu)/mL or a single-catheterized specimen with quantitative count of =/> 10(2) cfu/mL. For women with ASB in their prenatal screen or other high risk factors, consideration should be given to testing urine cultures every trimester until the completion of pregnancy to prevent the complications of persistent bacteriuria.
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Assimakopoulos SF, Kraniotis P, Gogos C, Marangos M. Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli. CEN Case Rep 2018; 7:90-93. [PMID: 29327131 DOI: 10.1007/s13730-017-0301-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
Acute pyelonephritis might be complicated by the formation of renal and perirenal abscesses and very rarely by renal vein thrombosis, which is a life-threatening condition. The main causative agents of acute pyelonephritis are enterobacteriaceae with the incidence of extended-spectrum beta-lactamase (ESBL)-producing strains increasing worldwide. We present the case of a 71-year-old Greek man with history of diabetes mellitus and recent hospitalization, who suffered from severe pyelonephritis with renal abscesses formation and associated bacteraemia caused by ESBL-producing Escherichia coli, complicated by extensive thrombosis of the ipsilateral renal vein and its branches, protruding also in the inferior venal cava. Our patient was effectively treated with anticoagulants and targeted antibiotic therapy, respectively, consisted of low molecular weight heparin transitioned to oral acenocoumarol for 3 months and 2-week course of intravenous meropenem followed by oral fosfomycin for additional 3 weeks as quidded by clinical and computed tomographic follow-up. In conclusion, in complicated urinary infections, caused by ESBL-producing enterobacteriaceae, oral fosfomycin might represent an effective option for step-down therapy of carbapenems, allowing the shortness of the duration of patient's hospitalization and carbapenem use.
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Affiliation(s)
- Stelios F Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
| | - Pantelis Kraniotis
- Department of Radiology, University General Hospital of Patras, 26504, Patras, Greece
| | - Charalambos Gogos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
| | - Markos Marangos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece
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Samadi K, Arellano RS. Drainage of Intra-abdominal Abscesses. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Case series summary Six cats were diagnosed with renal abscesses. Common clinical findings were lethargy, dehydration, abdominal pain and nephromegaly. Fever was noted in half of the cases. Diagnosis was established by ultrasonography, cytological examination and bacterial culture of abscess aspirates. At least one possible contributing factor could be identified in all cases. Antibiotics were consistently used and in two cats the abscess was surgically drained. The short-term outcome was fair but the long-term outcome was dependent on the underlying condition. Relevance and novel information The results of this small case series suggest that renal abscess should be considered when nephromegaly and/or abdominal discomfort are noted. Diagnosis of renal abscess is straightforward when ultrasonography and fine-needle aspirate analysis can be performed. Medical treatment is assumed to be preferable but surgical treatment may be warranted on a case-by-case basis. Given that almost every affected cat was diagnosed with at least one comorbidity, a thorough evaluation is recommended for all cats with renal abscesses.
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Affiliation(s)
- Mathieu R Faucher
- Alliance Small Animal Clinic, Internal Medicine Service, Bordeaux, France
| | - Marie-Laure Theron
- Department of Clinical Sciences, University of Toulouse, INP, National Veterinary School of Toulouse, Toulouse, France
| | - Brice S Reynolds
- Department of Clinical Sciences, University of Toulouse, INP, National Veterinary School of Toulouse, Toulouse, France
- Clinical Research Unit, University of Toulouse, INP, National Veterinary School of Toulouse, Toulouse, France
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Pyelonephritis and Abscesses of the Kidney. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Multifocal Renal Fungal Abscesses. Urology 2016; 93:e3. [DOI: 10.1016/j.urology.2016.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 11/20/2022]
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Abstract
Percutaneous abscess drainage (PAD) has been proven to be a safe, effective, and widely used technique for treatment of patients with intra-abdominal fluid collections. Indications for PAD are ever expanding, and most abscesses are amenable to PAD. PAD is routinely used for treatment of simple unilocular abscesses however more complex collections require a collaborative strategy with surgical services for patient management. PAD is also used as a temporizing procedure for patients who will ultimately require operative intervention. A variety of imaging modalities are used for PAD including ultrasound and CT. Several catheter insertion techniques have proven effective. Complications from PAD are relatively uncommon.
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Liu XQ, Wang CC, Liu YB, Liu K. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World J Nephrol 2016; 5:108-114. [PMID: 26788470 PMCID: PMC4707163 DOI: 10.5527/wjn.v5.i1.108] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/28/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.
METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed.
RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice. Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders.
CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.
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Current clinical management of renal and perinephric abscesses: a literature review. Urologia 2013; 81:144-7. [PMID: 24474535 DOI: 10.5301/urologia.5000044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 11/20/2022]
Abstract
Renal and perinephric abscesses are rare but very severe conditions resulting from infections in or surrounding the kidneys. Symptoms and imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI) and renal ultrasound (US) of higher quality have led to an early diagnosis that is very important for patients' prognosis. The best clinical approach to manage this disease is still debated. Antibiotic therapy represents the usual treatment of small renal abscesses. This management can be insufficient in case of larger renal abscesses requiring percutaneous or surgical drainage. Perinephric abscesses most commonly need invasive maneuvers. We conducted a literature review to clearly define the most recommended clinical managements for all cases of renal and perinephric abscesses.
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Abstract
The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.
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Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Room GG443, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
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Katsiari M, Nikolaou C, Roussou Z, Triantopoulou C, Apessou D, Platsouka E, Maguina A. Community acquired quinolone-resistant Escherichia coli pyelonephritis complicated with multiple renal abscesses: a case report. Hippokratia 2012; 16:381-383. [PMID: 23935324 PMCID: PMC3738619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acute pyelonephritis is a potentially organ-damaging and life-threatening infection. A 37-year old woman was admitted to Intensive Care Unit in septic shock and multi-organ failure due to acute pyelonephritis with systemic bacterial dissemination caused by a quinolone-resistant Escherichia coli. The patient, a previously healthy woman, reported recurrent episodes of urinary tract infection in the previous 3 years, which were treated with quinolones. Treatment course with broad-spectrum antimicrobial agents reversed her septic shock and multi-organ failure. However, pyelonephritis progressed to intrarenal and perirenal abscesses formation. The patient fully recovered after surgical removal of the infected kidney.
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Affiliation(s)
- M Katsiari
- Intensive Care Unit, Konstantopouleio General Hospital, Athens, Greece
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