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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Urinary tract infection (UTI) is a common problem treated by emergency physicians. A midstream urine sample remains the most frequent method of culture collection. Although midstream urine culture growing more than 10(5) colony-forming units per milliliter (cfu/mL) has been considered diagnostic of UTI, high false-positive and false-negative rates as well as a lack of precision have been associated with this method of collection. Alternative methods of establishing the diagnosis of UTI have excellent sensitivity and may be utilized at the time of patient presentation. These include the detection of leukocyte esterase activity in urine and the presence of one or more bacteria on microscopic examination of an unspun urine sample. Women of child-bearing age represent the vast majority of patients seen with UTI. Uncomplicated infection of the urinary tract has a generally benign course in these patients, and is rarely associated with long-term complications. In addition, these patients are infected with a predictable spectrum of uropathogens that respond to the commonly used antibiotics. It appears that urine cultures provide little additional information in this patient population. Urine cultures should be obtained in patients at high risk for pyelonephritis or bacteremia/urosepsis, as well as in those expected to have uncommon or resistant organisms.
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PMID:Utility of urine cultures in the emergency department. 394 79

Bacteremia constitutes a major challenge to the aged patient because the pathophysiological derangements that ensue pose an immediate threat to life. Compared to younger adults the elderly suffer bacteremia more frequently in association with pneumococcal pneumonia and salmonella enteritis/colitis. A prospective study to detect bacteremia was performed on 68 consecutive women with pyelonephritis requiring hospitalization. The data indicate that bacteremia occurs more frequently in elderly than in young women with nonobstructive pyelonephritis.
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PMID:Bacteremic urosepsis: a phenomenon unique to elderly women. 396 26

Twenty-six children received a single daily intravenous dose of ceftriaxone, 50 mg/kg, for a variety of bacterial infections including abscess (5), cellulitis (5), periorbital cellulitis (5), bacteremia without focus (4), osteomyelitis (2), pneumonia (2), pyelonephritis (2) and otitis media (1). Organisms isolated from infectious foci were Staphylococcus aureus (9), Streptococcus pneumoniae (6), Streptococcus pyogenes (3), Escherichia coli (2); and Haemophilus influenzae type b, nontypable H. influenzae, Group B streptococcus, Pasteurella multocida, Haemophilus parainfluenzae and satelliting streptococcus (1 each). Microbiologic cure was achieved in 20 of 22 (91%) infections and clinical cure in 25 of 26 (96%). Fifteen possible adverse reactions occurred in 34 patients evaluable for drug safety; most were mild and self-limited. Neutropenia developed in two patients necessitating discontinuation of ceftriaxone in one, followed by prompt resolution. Seventeen children received ceftriaxone, 75 mg/kg/day, in two divided doses for a similar variety of infections. Bacteriologic and clinical cure rates of 100 and 94%, respectively, were demonstrated. Leukopenia developed in one patient and resolved when ceftriaxone was discontinued. Once a day dosing of ceftriaxone in pediatric patients provides greater ease of administration combined with efficacy equal to that achieved with a divided dosage schedule.
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PMID:Ceftriaxone administered once or twice a day for treatment of bacterial infections of childhood. 396 62

A pregnant woman allergic to penicillin was successfully treated with erythromycin for pyelonephritis and bacteremia caused by Lactobacillus.
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PMID:Lactobacillemia in pregnancy. 403 43

The demonstration of bacterial antigens in active pyelonephritis in man has been inconsistent. In this paper we have studied 110 rats with experimental pyelonephritis induced by a single intravenous injection of Streptococcus faecalis. The animals were studied at intervals up to 1 year; bacteremia, urine and renal parenchymal bacterial counts were monitored. In these animals it was observed that bacteriuria and positive bacterial cultures of renal tissue persisted up to 1 year in some rats. Bacteria and their antigenic products in small foci were detected by immunofluorescence in the pyelonephritic lesions. The highly focal distribution of the bacterial antigens in bacteriologically positive tissues of this model suggest the need for careful fixation technics, availability of large tissue specimens and careful control of immunologic factors. These specific requirements to detect bacterial antigens may preclude the practical study of human pyelonephritic kidneys.
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PMID:Hematogenous Streptococcus faecalis pyelonephritis in the rat. A histologic, immunopathologic and bacteriologic study. 421 38

Retrograde pyelonephritis was produced in rats by introducing into the bladder a small refluxing inoculum of Escherichia coli that would enter the renal pelvis but not the blood stream. At the same time the left ureter was partially obstructed for 18 hours. This model differs from previous attempts to produce E coli pyelonephritis with large (0.6 ml) volumes infused into the bladder, because such large volumes cause bacteremia and hematogeneous pyelonephritis. Since retrograde E coli pyelonephritis in patients is not accompanied by positive blood cultures, the model described in this report is believed to accurately mimic human pyelonephritis and to allow a realistic approach to the study of immunity against retrograde infection in the urinary tract.
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PMID:Immunization against retrograde pyelonephritis. I. Production of an experimental model of severe ascending Escherichia coli pyelonephritis without bacteremia in rats. 459 Jun 45

Vaccination with heat-killed or formalinized cells of E coli 0:111, or E coli 06 (Williams), prevented retrograde E coli pyelonephritis. Since there was no bacteremia and no urinary antibody, the vaccination appeared to protect by immune reactions operating in the kidney itself. The vaccine failed to protect against a highly virulent form of E coli 06 (Riffle), possibly because the amount of antibody to its lipopolysaccharide was inadequate. Since all three strains possessed K antigen in approximately equal amounts, the difference in results was not attributed to its presence.
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PMID:Immunization against retrograde pyelonephritis. II. Prevention of retrograde Escherichia coli pyelonephritis with vaccines. 459 Jun 46

Female rats deprived of water overnight, and then given 1.0 ml of E coli 0111:B4 via the urethra, developed pyelonephritis. A nearly absolute association was found between the occurrence of bacteremia after the transurethral infusion and the development of pyelonephritis. An identical lesion was produced by a combination of forniceal damage and intravenous injection of E coli. The kidney damaged by reflux was shown to be more susceptible to hematogenous pyelonephritis than the obstructed kidney and the distribution of the infection was due to localization of bacteria in the damaged fornix but not to the route of infection. The induction of retrograde E coli pyelonephritis in the rat required a tear in the pelvic epithelium creating pyelovenous communications, and the resultant bacteremia produced pyelonephritis. The incidence of ureteral reflux and the volume of inoculum that refluxed to the renal pelvis was shown radiologically to be a function of bladder distensibility, which is reduced by withholding water for a few hours. In this system, retrograde E coli pyelonephritis developed from a combination of two factors: (1) reflux-induced damage to the renal pelvis so that E coli are introduced into the kidney and (2) hematogenous infection of the damaged kidney.
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PMID:Bacteremia in the pathogenesis of retrograde E. coli pyelonephritis in the rat. 494 81

Epidemiological data show that O18:K1 Escherichia coli is a common cause of neonatal bacteremia and meningitis. These bacteria were capable of multiplying in the bloodstream of newborn rats and were resistant to the bactericidal effects of complement in the absence of specific antibodies. The roles played by the O antigen and the K antigen in complement resistance were analyzed by comparing the bactericidal effects of normal sera and of sera deficient in various complement components or in immunoglobulins. These sera were tested on O18:K1 bacteria and on mutants lacking either the lipopolysaccharide O antigen or the K1 capsular polysaccharide. In addition, O1:K1 cells, which can cause pyelonephritis but which are rare in newborn meningitis and which do not multiply in the bloodstream of newborn rats, were also examined. Different mechanisms of protection against the alternative and classical pathways were recognized: K1-positive cells were resistant to the bactericidal activity of sera deficient in classical complement pathway components, whereas K1-negative cells were sensitive to these sera. Based on these results and on those from complement fixation assays, the K1 sialic acid polysaccharide impedes the activation of, and thus protects the bacteria against, the alternative complement pathway. Not only the K1-negative mutant cells but also O1:K1 bacteria and mutants lacking the O18 oligosaccharide repeating units of the lipopolysaccharide were sensitive to the classical complement pathway. These bactericidal effects were observed even in the absence of specific antibodies. It is proposed that both the K1 capsule and the O18 oligosaccharide restrict antibody-independent classical pathway activation by shielding deeper structures on the cell membrane that are capable of activating this pathway.
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PMID:Role of the capsule and the O antigen in resistance of O18:K1 Escherichia coli to complement-mediated killing. 619 96

Amdinocillin in combination with another beta-lactam antibiotic (ampicillin, cephalothin, cefamandole or cefoxitin) was used to treat 25 patients with pyelonephritis (with or without bacteremia), pneumonia, bacteremia secondary to intravenous devices, and urinary tract infections (with catheter in place) due to gram-negative organisms. The combination resulted in a clinical response in 96 percent of the patients and a bacteriologic response in 100 percent at 72 hours. Few toxic effects were seen. At long-term follow-up, relapse occurred in three of 10 patients with pyelonephritis who were treated with a combination regimen and completed their course of antimicrobial therapy with a beta-lactam antibiotic. Reinfection occurred in one patient who had a urinary tract infection with a catheter in place. In vitro testing showed that the cefamandole-amdinocillin combination most frequently produced synergy against the strains of Escherichia coli isolated. Synergy with the antibiotic combinations was also seen against strains of Klebsiella pneumoniae. It was difficult to correlate the in vitro test results with the in vivo therapeutic effect of these antibiotic combinations.
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PMID:Amdinocillin in combination with beta-lactam antibiotics for treatment of serious gram-negative infections. 631 Oct 14


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