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

A prospective study was carried out of the clinical, laboratory, radiologic and therapeutic features of acute, symptomatic, bacterial pyelonephritis as experienced by 12 consecutive elderly, noncatheterized men who required hospitalization. In spite of the advanced ages of the men and the inordinate frequency of bacteremia and septic shock, no patient died. "Appropriate" antibiotic therapy, supportive treatment, and, as importantly, a lack of associated "imminently" or "ultimately" fatal illnesses contributed to the 100 per cent survival rate. Guidelines are provided for the diagnostic evaluation and antibiotic therapy of community-acquired pyelonephritis in elderly men.
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PMID:Symptomatic pyelonephritis in elderly men. 713 May 75

The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). No deaths, clinical evidence of septic shock, or cases of postinfection endocarditis were found. The most common bloodstream isolates were Escherichia coli (57), group B streptococcus (28), and Bacteroides sp (26). The patients with endoparametritis had a fever index of 86.2 +/- 47.1F-hours, an average hospital stay of 6.5 +/- 3.1 days, a 7.3% rate of complications, and a 19.5% rate of failure of primary antibiotics. The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.
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PMID:Bacteremia in obstetrics: clinical course. 730 Dec 39

Patterns of fever, shock, and chills in 100 episodes of febrile, Gram-negative bacillemia were retrospectively analyzed to determine features predictive of the site of infection, organism, and prognosis. Pneumonias most often produced morning temperature rises, whereas infections in other sites were usually associated with an afternoon or evening peak. Peritonitis (usually due to Bacteroides fragilis) tended to cause an indolent temperature rise (over a day or more), whereas pyelonephritis and cholangitis typically produced an abrupt "spike." Relatively low fevers characterized Enterobacter pneumonias while very high fevers were noted in Pseudomonas aeruginosa infections in patients with leukemia. Chills occurred with unusually high frequency in cholangitis and in Klebsiella bacteremia. Patients going into shock had higher fevers than those who did not. More importantly, the development of shock was shown to be related to severity of underlying disease. Shock never developed if the disease was not serious, unless the bacteremia was caused by instrumentation, but occurred in 73% of patients with leukemia or lymphoma. The clinical setting, pattern of fever, and presence or absence of a chill can in many cases usefully guide diagnosis and therapy in patients with Gram-negative bacillemia.
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PMID:Fever, shock and chills in gram-negative bacillemia: clinical correlations in 100 cases. 731 Dec 56

Urinary tract infections involving Proteus mirabilis may lead to complications including bladder and kidney stones, acute pyelonephritis, and bacteremia. This bacterium produces a number of fimbriae, two of which, MR/P fimbria and P. mirabilis fimbria, have been shown to contribute to the ability of this pathogen to colonize the bladder and kidney. We have now purified and characterized a previously undescribed fimbria of P. mirabilis, named ambient-temperature fimbria (ATF). Electron microscopy of a pure preparation and immunogold labeling of cells demonstrated that ATF was fimbrial in nature. The major fimbrial subunit of ATF has an apparent molecular weight of 24,000. The N-terminal amino acid sequence, E-X-T-G-T-P-A-P-T-E-V-T-V-D-G-G-T-I-D-F, did not show significant similarity to that of any previously described fimbrial protein. ATF was expressed by all eight P. mirabilis strains examined. Culture conditions affected expression of ATF, with optimal expression observed in static broth cultures at 23 degrees C. This fimbria was not produced by cells grown at 42 degrees C or on solid medium. Expression of ATF did not correlate with mannose-resistant/Proteus-like (MR/P) or mannose-resistant/Klebsiella-like (MR/K) hemagglutination and represents a novel fimbria of P. mirabilis.
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PMID:Proteus mirabilis fimbriae: identification, isolation, and characterization of a new ambient-temperature fimbria. 790 38

Escherichia coli strains isolated from the urine in 49 consecutive episodes of community-acquired pyelonephritis in adult women were characterized for adhesins and hemolysin production. The mean age of the patients was 56 years and 47% had at least 1 compromising condition. P fimbriae was found in 67% and hemolysin production in 35% of the strains; these figures were significantly (p < 0.001) higher than the corresponding figures (11% for each) among 287 strains isolated from stool of healthy adults (Siitonen A. J Infect Dis 1992; 166: 1058-1065). The prevalence of Non-P mannose-resistant adhesins and type 1C fimbriae was low (4 and 8%, respectively) and did not differ significantly from the corresponding prevalences (1 and 7%) in healthy adults. 74% fo the pyelonephritic (but only 22% of the stool) isolates had at least 1 of these 4 virulence factors (p < 0.001) and 37% and 7%, respectively, had at least 2 (p < 0.001). Nevertheless, the strains represented a wide variety of O:K serotypes without any indication of specially virulent clones. Of the 49 patients 15 had concomitant bacteremia, and in all except 2 compromised elderly patients the urinary and blood isolates were identical.
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PMID:Community-acquired pyelonephritis in adults: characteristics of E. coli isolates in bacteremic and non-bacteremic patients. 793 28

Proteus mirabilis, commonly associated with urinary tract infection, pyelonephritis and bacteremia, produces a number of fimbriae, including PMF (P. mirabilis fimbriae). Genes encoding PMF were isolated and the complete nucleotide (nt) sequence was determined. The pmf gene cluster, encoded by 5655 bp, predicts five polypeptides: PmfA (18,921 Da), PmfC (93,107 Da), PmfD (28,208 Da), PmfE (38,875 Da) and PmfF (19,661 Da). PmfA, PmfC, PmfD and PmfF share > 25% amino acid (aa) sequence identity with gene products of the pap, mrp and sfa fimbrial gene clusters. PmfE shares no similarity with any polypeptide in the SwissProt database. No regulatory gene(s) or regulatory elements were evident in the sequence. The pmf cluster shares common features with other enteric fimbrial gene clusters, but also displays features that are unique.
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PMID:Genetic organization and complete sequence of the Proteus mirabilis pmf fimbrial operon. 795 33

Catheter-associated bacteriuria is the most common infection acquired in long-term care facilities. Complications include fever, acute pyelonephritis, bacteremia, catheter obstruction, urinary stones, chronic interstitial nephritis, renal failure, and death. The closed-catheter system has been the only innovation in this traditional method of care that has led to prevention of bacteriuria. Antimicrobial agents rarely are indicated to prevent or treat bacteriuria in long-term catheterized patients, except for those with symptomatic infection. Alternative devices are available and often may be preferable to the indwelling urethral catheter. These patients and their reservoirs of bacteriuric organisms are sources of nosocomial outbreaks. Such outbreaks can be prevented and controlled with attention to catheter hygiene, prevention of patient-to-patient transmission on the hands of caregivers, and possibly use of antimicrobials to diminish bacterial concentrations in the urine.
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PMID:Catheter-associated bacteriuria in long-term care facilities. 798 52

Proteus mirabilis, a common agent of bacteriuria in humans, causes acute pyelonephritis and bacteremia. Renal epithelium provides a barrier between luminal organisms and the renal interstitium. We have hypothesized that P. mirabilis may be internalized into renal epithelium. To test this hypothesis, we added suspensions of three P. mirabilis strains (10(8) CFU) to confluent monolayers of primary cultures of human renal proximal tubular epithelial cells (HRPTEC) and, after 3 h, found the bacteria internalized within membrane-bound vacuoles by light and electron microscopy. Internalization of bacteria by HRPTEC was corroborated by using the gentamicin protection assay. Cytolysis of HRPTEC by the HpmA hemolysin, however, was a confounding factor in this assay, and therefore a hemolysin-negative hpmA mutant was used in subsequent experiments. The nonhemolytic mutant WPM111 did not disrupt the monolayer and was recovered in numbers that were 10- to 100-fold higher than those of the hemolytic parent BA6163. Cytochalasin D (20 micrograms/ml) inhibited internalization of Salmonella typhimurium but not that of P. mirabilis, suggesting that the latter species enters HRPTEC by a mechanism that is not dependent on actin polymerization. We suggest that HpmA hemolysin-mediated cytotoxicity and internalization of bacteria by HRPTEC may play a role in the development of Proteus pyelonephritis.
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PMID:Internalization of Proteus mirabilis by human renal epithelial cells. 803 79

Staphylococcus aureus remains a prominent cause of community- and hospital-acquired infection. This study reviewed 162 cases of S. aureus infection occurring in 120 adults who were hospitalized at a Veterans Affairs Medical Center and referred for consultation to the Infectious Disease Service. There were 37 cases of skin and soft tissue infection, 5 pyomyositis, 34 osteomyelitis, 13 septic arthritis, 19 pneumonia, 3 empyema, 5 pyelonephritis, 37 vascular infection, 3 epidural abscess, and 6 miscellaneous infections. Bacteremia was documented in 56 of 119 (47%) cases in which blood cultures were obtained, indicating the serious nature of the infections in many cases. Staphylococcus aureus is widely prevalent in healthy persons. Given its ubiquity and the capacity to cause a broad array of infections, an effective host response must play an important role in preventing infection. This host response is immunologically nonspecific, in that it depends upon the effectiveness of mechanical barriers to invasion and, once invasion takes place, the interaction of PMN, complement, and antibody that is probably present in serum of all immunologically competent adults rather than sensitization of B or T lymphocytes by any identifiable antigens specific to S. aureus. Analysis of the present cases calls attention to S. aureus as an opportunistic pathogen, 1 that only infrequently causes serious infection in otherwise healthy persons. Nearly every patient in this series had 1 or more medical condition thought to predispose to infection; 279 such conditions were identified, representing an average of 2.3 per person. A break in the natural barrier to infection was also present in the majority of cases, for example, trauma, wound, or pre-existing decubitus ulcer in skin and soft tissue infections; endotracheal tube in pneumonia; and a catheter bypassing urethra or skin in urinary and vascular infections, respectively. The tendency for patients to be infected with S. aureus repeatedly (mean number of infections, 1.4 per patient) reflects the chronicity of many predisposing factors and, perhaps, of colonization as well. Staphylococcus aureus has a special predilection to cause infections involving prosthetic devices, perhaps related to its affinity for fibronectin, laminin, and other serum proteins that can mediate attachment to foreign material; 46 of 162 (28%) infections were associated with the presence of a foreign body. Such infections are difficult to eradicate with antibiotic therapy alone, perhaps because of a change in the metabolic state of adherent bacteria, and removal of the foreign body is generally required for cure.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The current spectrum of Staphylococcus aureus infection in a tertiary care hospital. 804 Dec 42

Bacteremia develops in a subgroup of patients with acute pyelonephritis. This study examined isolates of Escherichia coli from the urine and the blood of 25 bacteremic and 67 nonbacteremic women with this acute disease. P-fimbriated strains were found in 100% of bacteremic patients without complicating factors but in only 71% of nonbacteremic patients without complications (P < .05). Non-P-fimbriated strains were only found to cause bacteremia in three patients with compromising host factors. Strains from the bacteremic group and those from the nonbacteremic group did not differ significantly in terms of hemolysin or aerobactin production or of serum resistance. The P-fimbriated strains from both groups of patients carried pap DNA sequences of the papGIA2 adhesin type; prsGJ96 homologous DNA sequences were rare. The results suggested that P fimbriae and compromising host conditions independently increase the risk for bacteremia during acute pyelonephritis.
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PMID:Virulence factors and pap genotype in Escherichia coli isolates from women with acute pyelonephritis, with or without bacteremia. 808 34


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