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What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?

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Asian Journal of Urology 2022年第2期9卷 146-151页

作者： JoséIván Robles-Torres Marco Alberto Ocaña-Munguía JoséGustavo Arrambide-Herrera Adrián Mauricio Martínez-Fernández Rodrigo Romero-Mata Lauro Salvador Gómez-Guerra Urology Department Hospital Universitario"Dr.Jose´Eleuterio Gonza´lez"Universidad Auto´noma de Nuevo LeonMonterreyNuevo LeonMexico

Objective:To describe the microbiological characteristics in emphysematous pyelonephritis(EPN),demonstrate the frequency of extended-spectrum beta-lactamase(ESBL)microorganisms,and determine if these microorganisms are associated with the prognosis of patients with EPN.Methods:We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016.Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms.Statistical significance was set with p<0.05.Results:A total of 63 patients were included;55(87.3%)of them were females,with a median age of 55(interquartile range:45-65)years.Conservative management was indicated in 38.1%;42.9%were treated with ureteral stent;12.7%with open or percutaneous drainage;15.8%with early nephrectomy;and 9.5%with delayed nephrectomy.Reported mortality was 13(20.6%)cases;23(36.5%)cases required admission to the intensive care unit.The most frequent microorganism isolated was Escherichia coli(n=34,53.9%).ESBL microorganisms were found in 31.7%of the population.No significant association of ESBL was found with admission to the intensive care unit,or with increased mortality.Conclusions:To our knowledge,this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN.Risk factors associated with a poor prognosis in patients with EPN have been described.The microbiological factors,specifically ESBL-producing bacteria,do not seem to influence in the prognosis of these patients.

关键词： emphysematous pyelonephritis Extended spectrum betalactamase Mortality Intensive care unit admission

Serratia fonticola and its role as a single pathogen causing emphysematous pyelonephritis in a non-diabetic patient:A case report

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World Journal of Clinical Cases 2022年第29期10卷 10600-10605页

作者： Victor Villasuso-Alcocer Juan P Flores-Tapia Fernando Perez-Garfias Andrea Rochel-Perez Nina Mendez-Dominguez Scholar at Direccion General de Calidad y Educacion en Salud Secretaría de SaludMexico 11570Mexico Urology Department Hospital Regional de Alta Especialidad de la Peninsula de YucatanMerida 97300YucatanMexico Research and Learning Hospital Regional de Alta Especialidad de la Peninsula de YucatanMerida 97130YucatanMexico

BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades,frequently associated with Escherichia coli and other anaerobic,gas-forming bacteria and mostly in patients living with diabetes.We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis.CASE SUMMARY A 38-year-old female presented with fever,severe pain in the right flank and changes in urinary habits.She was admitted,and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures;the latter showed Serratia fonticola as a single pathogen.After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile,and the gas presence reduced.CONCLUSION emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening.This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.

关键词： Serratia fonticola emphysematous pyelonephritis Urinary tract infections Nephrolithiasis Case report

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

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World Journal of Clinical Cases 2021年第12期9卷 2862-2867页

作者： Yi Jiang Richard Lo Zhen-Quan Lu Xiao-Bao Cheng Lin Xiong Bing-Feng Luo Department of Surgery The University of Hong Kong-Shenzhen HospitalShenzhen 518053Guangdong ProvinceChina

BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

关键词： emphysematous pyelonephritis Necrotizing infection Autosomal dominant polycystic kidney disease Flexible ureteroscopy lithotripsy Endoscopic surgery Lithotripsy Case report

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

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World Journal of Clinical Cases 2021年第11期9卷 2584-2594页

作者： Zhou-Xiong Xing Hang Yang Wen Zhang Yu Wang Chang-Sheng Wang Tao Chen Hua-Jun Chen Department of Critical Care Medicine Affiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina Department of Anesthesiology Affiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina

BACKGROUND emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the past two decades,pointof-care ultrasound(POCUS)has been widely used in clinical practice,especially in emergency and critical care settings,and helps to rapidly identify the source of infection in sepsis.We report a rare case in which a“falls”sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission.He went to the emergency room,and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts.This imaging feature was like a mini waterfall.His blood and urine culture demonstrated Escherichia coli bacteremia,and EPN associated with septic shock was diagnosed.The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed.He subsequently underwent computed tomography-guided percutaneous catheter drainage,and fully recovered.We also review the literature on the sonographic features of POCUS in EPN.CONCLUSION This case indicates that a“falls”sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.

关键词： emphysematous pyelonephritis Point-of-care ultrasound Ultrasound Urinary

emphysematous pyelonephritis in a Black African Woman Managed with Antibiotics Alone

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Open Journal of Nephrology 2016年第4期6卷 151-156页

作者： Kossi Akomola Sabi Béfa Noto Kadou Kaza Eyram Yoan Amekoudi Jacques Vigan Vicko Manou Dazé Apollinaire Gnionsahe Department of Nephrology and Hemodialysis Sylvanus Olympio University Teaching Hospital Lomé Togo

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

关键词： emphysematous pyelonephritis Africa Togo

An alveolate kidney:A case report of emphysema pyelonephritis

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Journal of Acute Disease 2022年第2期11卷 85-87页

作者： De-Gang Wang Jian-Jiao Chen Department of Emergency Surgery Chaoyang Municipal Central HospitalLiaoning ProvinceChina Department of General Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina

Rationale:emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.

关键词： emphysematous pyelonephritis CT Conservative management