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

The regulation of intracellular concentrations of organic solutes, including glycine betaine, is an important adaptive response to osmotic stress for Escherichia coli. The clinical significance of glycine betaine to uropathogens is not clear. Clinical isolates of E. coli, Klebsiella pneumoniae, Enterobacter species, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, S. saprophyticus, and Enterococcus faecalis accumulated glycine betaine from hyperosmotic media. The addition of glycine betaine to hyperosmotic minimal medium accelerated the growth rates of all species tested except P. mirabilis. However, when clinical strains of E. coli were transferred from urine with low osmolality to hyperosmotic urine, there was no slowing of the growth rate. There was no difference in growth rates of E. coli isolates from acute pyelonephritis, cystitis, and asymptomatic bacteriuria nor from fecal isolates. The ability to accumulate osmolytes, although it may be a factor in the adaptation to hypertonic environments, was not related to virulence.
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PMID:Is the ability of urinary tract pathogens to accumulate glycine betaine a factor in the virulence of pathogenic strains? 883 91

Renal subcapsular abscess is a very rare disease that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. The course and management of subcapsular abscesses have received less attention than those of renal and perirenal abscesses. We describe a 63-year-old diabetic woman who presented with intermittent fever of 1 month's duration. She was initially treated for suspected acute pyelonephritis then referred to our hospital because of poor clinical response to cefazolin plus gentamicin. Computed tomography of the abdomen revealed a huge subcapsular abscess with displacement and compression of the left renal parenchyma. A percutaneous catheter was inserted and left in place for 8 days; a total of approximately 850 mL of pus was drained. Culture of the pus yielded Klebsiella pneumoniae and Enterobacter cloacae. A 2-week course of moxalactam was administered on the basis of the results of in vitro antibiotic susceptibility testing. The distorted renal parenchyma appeared normal at sonographic follow-up examination 3 weeks after hospitalization. The course and management of this rare entity are presented as a reminder to physicians that renal subcapsular abscess could manifest as fever of unknown origin in a diabetic patient. A high degree of clinical suspicion is required for early diagnosis and treatment in order to achieve a satisfactory outcome.
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PMID:Course and management of renal subcapsular abscess in a 63-year-old diabetic woman. 948 Oct 71

The results of the bacteriological investigation of the secretion from the trachea, large bronchi and fauces of 36 newborns (including 27 preterms) with severe pneumonia were analyzed. 20 of them were born of women with complicating somatic, obstetric and gynecologic histories: candidiasis, herpes genitalis, chronic endometritis, adnexitis or chronic pyelonephritis that could be the risk of the fetus intranatal infection. During the acute period of pneumonia in the newborns within the first 4-8 days of life mainly Pseudomonas aeruginosa was isolated (51.3 per cent), Staphylococcus epidermidis, S. haemolyticus and Enterococcus faecalis were less frequent (18.9, 8.1 and 5.4 per cent, respectively). Klebsiella pneumoniae, Streptococcus anhaemolyticus and other organisms were extremely rare. On the whole the gramnegative microflora predominated. The study of the antibiotic susceptibility showed that the majority of the P. aeruginosa isolates were susceptible to amikacin and polymyxin B, the isolates susceptible to ceftazidime were less frequent, 20-25 per cent of the isolates were susceptible to ciprofloxacin, cefoperazone and imipenem and practically no isolates were susceptible to gentamicin. The S.epidermidis isolates were susceptible to rifampicin and vancomycin and in rare cases to fusidin and amikacin and resistant to oxacillin. When the treatment course was more than 15 days, the isolates proved to be susceptible to 1/3 of the presently available antibiotics. Because of the host low protective forces, peculiarities of the infection pathways and high frequency of the resistant strains it is valid to include netilmicin, imipenem, cefoperazone and ceftriaxone to the complex therapy of the newborns along with the substitution immunotherapy.
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PMID:[Antibiotic sensitivity of pneumonia pathogens in newborns and problems of antibacterial therapy of the pathologic process]. 1007 63

Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.
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PMID:Antibiotic prophylaxis in children with relapsing urinary tract infections: review. 1078 49

Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by Klebsiella pneumoniae. Diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.
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PMID:Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy. 1085 80

The purpose of the study was to investigate the management of pyelonephritis in a large Italian pediatric population. A total of 1,333 patients (36% male) were considered. Escherichia coli was the most frequently isolated agent (89.9%), followed by Proteus mirabilis (3.6%) and Klebsiella oxytoca (2.1%). 27% of microorganisms were resistant to amoxicillin, 4% to amoxicillin/clavulanic acid, 11% to trimethoprim-sulfamethoxazole, 2.4% to gentamicin and less than 2% to ceftazidime. Despite this resistance pattern showing that oral antibiotics, such as amoxicillin/clavulanic acid, are effective in vitro as well as parenteral antimicrobials, a parenteral antibiotic was given initially to 756 (57.2%) children. A prophylactic regimen was started in 922 patients with a rate of reinfection during prophylaxis of 9.5%; a higher rate of reinfection was observed in patients with reflux (25%) compared to children without reflux (3%) (p < 0.0001). Vesicoureteral reflux was demonstrated in 30% of patients. The number of renal abnormalities detected by DMSA in patients with and without reflux was significantly different (p < 0.001). CRP was higher in patients with scars (p < 0.02). In conclusion, pyelonephritis represents a common disease with about 2,500 days of hospitalization per year in the Veneto Region where there is a pediatric population of about 800,000 under 15 years of age. The results of antimicrobial in vitro tests indicate that amoxillicin/clavulanic acid could represent the antibiotic of choice. The high frequency of malformations, observed even in children between 6 and 12 years of age, may suggest the need of an imaging study including DMSA scan and VCUG in all age groups.
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PMID:Retrospective study of children with acute pyelonephritis. Evaluation of bacterial etiology, antimicrobial susceptibility, drug management and imaging studies. 1174 99

We report a 34-year-old male patient without prior medical history who presented with acute renal failure due to acute bacterial pyelonephritis. Both blood and urine cultures grew Klebsiella pneumoniae. Although a kidney biopsy revealed extensive necrosis and no viable glomeruli, renal function recovered to near normal after intermittent hemodialysis and antibiotic therapy. We believe that it is important to include this entity in the differential diagnosis of acute renal failure since proper diagnosis and treatment is essential for recovery of renal function. Furthermore, we would like to draw attention to Klebsiella pneumoniae as an important potential pathogen in such cases, in addition to Escherichia coli.
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PMID:Acute renal failure caused by Klebsiella pneumoniae pyelonephritis. 1175 11

The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. The etiology of UTI is also affected by underlying host factors that complicate UTI, such as age, diabetes, spinal cord injury, or catheterization. Consequently, complicated UTI has a more diverse etiology than uncomplicated UTI, and organisms that rarely cause disease in healthy patients can cause significant disease in hosts with anatomic, metabolic, or immunologic underlying disease. The majority of community-acquired symptomatic UTIs in elderly women are caused by E coli. However, gram-positive organisms are common, and polymicrobial infections account for up to 1 in 3 infections in the elderly. In comparison, the most common organisms isolated in children with uncomplicated UTI are Enterobacteriaceae. Etiologic pathogens associated with UTI among patients with diabetes include Klebsiella spp., Group B streptococci, and Enterococcus spp., as well as E coli. Patients with spinal cord injuries commonly have E coli infections. Other common uropathogens include Pseudomonas and Proteus mirabilis.Recent advances in molecular biology may facilitate the identification of new etiologic agents for UTI. The need for accurate and updated population surveillance data is apparent, particularly in light of concerns regarding antimicrobial resistance. This information will directly affect selection of empiric therapy for UTI.
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PMID:The etiology of urinary tract infection: traditional and emerging pathogens. 1211 67

The analysis of the sensitivity of 195 enterobacterial cultures to bile revealed that their level of resistance decreased in the following row: Shigella > Salmonella > Klebsiella > Escherichia > Providencia. As shown on a sample of 136 E. coli isolates the level of resistance of these bacteria to bile depended on their isolation source: in E. coli isolated from bile in cholecystitis, from urine in pyelonephritis and from feces in intestinal dysbacteriosis resistance was 1.1-1.3 times higher than in E. coli isolated from the water of open reservoirs, from the feces of healthy persons and from extraintestinal foci of purulent inflammation. The level of sensitivity to bile is regarded as a property making it possible for enterobacteria to colonize biliary tracts and the proximal sections of the digestive tract.
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PMID:[Comparative analysis of the sensitivity of enterobacteria to bile]. 1214 Oct 44

The efficacy and safety of intravenous (i.v.) ertapenem (1 g once a day) with the option to switch to an oral agent for treatment of adults with complicated urinary tract infections (UTIs) were compared with that of i.v. ceftriaxone (1 g daily) with the same oral switch option in a multicenter, double-blind, prospective, randomized study. At entry, 592 patients were assigned to one of two strata: acute pyelonephritis or other complicated UTI without acute pyelonephritis. After a minimum of 3 days, patients could be switched to an oral antimicrobial agent. A total of 159 patients in the ertapenem group and 171 patients in the ceftriaxone group were microbiologically evaluable. Approximately 95% of patients in each treatment group were switched to oral therapy. The most common pathogens were Escherichia coli and Klebsiella pneumoniae. At the primary efficacy endpoint 5 to 9 days after treatment, 91.8% of patients who received ertapenem and 93.0% of those who received ceftriaxone had a favorable microbiological response (95% confidence interval for the difference, adjusting for strata, -7.6 to 5.1%), indicating that outcomes in the two treatment groups were equivalent. Microbiological success rates for the two treatment groups were similar when compared by stratum and also by severity of infection. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. In this study, ertapenem was as effective as ceftriaxone for the initial treatment of complicated UTIs in adults, was generally well tolerated, and had a similar overall safety profile.
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PMID:Ertapenem versus ceftriaxone followed by appropriate oral therapy for treatment of complicated urinary tract infections in adults: results of a prospective, randomized, double-blind multicenter study. 1218 44


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