Risk factors for treatment failure in renal suppurative infections

Acute focal bacterial nephritis, pyonephrosis and renal abscess in children

BACKGROUND-AIM

Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre.

PATIENTS AND METHODS

The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed.

RESULTS

Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to 13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 days, and emergency surgery was required in three cases. During follow-up, 13 patients underwent corrective surgery. Permanent renal lesions were identified in 16 patients.

CONCLUSIONS

AFBN, renal abscess and pyonephrosis should be suspected in children with severe presentation and urological history. Appropriate imaging is crucial for management planning. Prognosis is often guarded despite appropriate treatment. Based on the results of this study we propose a management algorithm.

[Incidence of surgical site infections in a urology department]

OBJECTIVES

To determine the incidence of surgical site infections (SSI) in the urology wards as well as the SSI incidence in relation to the ASA score and surgical site contamination class.

MATERIALS AND METHODS

One-year prospective cohort study was conducted in the Urologic department, General hospital, Sabac. The patients were daily examined and their diagnoses were made according to the definition of hospital infections using concurrently the ASA score and surgical site contamination class.

RESULTS

Out of 241 operated patients, 32 patients were diagnosed with 33 SSI. The overall incidence rate of patients with SSI was 5.9% while incidence rate of SSI was 6.1%. There were not the differences in the incidence rates according to the ASA score of patients (p > 0.05). The incidence of SSI was 5.0% in the clan wounds, 11.2% in the clean-contaminated, and 20.7% in the contaminated wounds (Chi2 = 8.2 DF = 2 p < 0.016). The patients with SSIs were hospitalized approximately 2 times longer than the patients without SSI (t = -6.28; df = 239; p < 0.001).

CONCLUSION

This study suggests that it is necessary to maintain continuous surveillance of surgicical site infections and to implement the preventive measures, especially for clean and clean-contaminated surgery.

Scoring system development and validation for initial treatment failure in suppurative kidney infections

BACKGROUND

Suppurative kidney infections (SKIs) have potentially lethal implications and a high incidence of treatment-related morbidity and death. Until this point, there has been no study that has derived a prognostic model for adverse early outcomes in SKI. Therefore, our aim was to derive and validate a simple scoring system of early treatment failure in SKI.

METHODS

Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of early treatment failure using patient characteristics, severity of disease, bacterial etiology, type of pathology, initial antibiotic therapy, and early urologic procedures.

RESULTS

This study included 92 adult patients with 104 SKIs. Early treatment failure was observed in 57 patients (54.8%). The length of the hospital stay and the treatment complications were significantly longer and more common, respectively, in patients with early treatment failure. The factors associated most strongly with early treatment outcome were whether there had been an early complete urologic procedure, the adequacy of early antibiotic therapy, and the presence or absence of sepsis syndrome. The total possible score ranged from 0 to 22 points, with a cut-off value of 5 points. A score of ≤ 5 points identified early success correctly in 85.3% of patients, whereas a score > 5 points correctly identified early failure in 93.2%. The scoring system retained its predictive ability on the validation set.

CONCLUSION

A scoring system was created to predict early treatment failure for a given patient with SKI. Although the system has good performance characteristics and provides a possible intervention measure, further studies should be performed before widespread implementation.