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Hayano S, Hidaka T, Tadakuma R, Kashima M. Diagnostic Accuracy of Point-of-Care Gram Stains in Obstructive Pyelonephritis due to Ureteral Stones. Open Forum Infect Dis 2024; 11:ofae026. [PMID: 38444822 PMCID: PMC10913829 DOI: 10.1093/ofid/ofae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Background The diagnostic utility of point-of-care (POC) Gram stains for obstructive pyelonephritis with hydronephrosis is not well established. The current study aimed to assess the diagnostic accuracy of urine Gram stains in patients with obstructive pyelonephritis due to ureteral stones. Methods A retrospective observational study was conducted on patients with obstructive pyelonephritis admitted to our hospital between January 2011 and December 2021. The diagnostic accuracy of Gram stains was evaluated based on the severity of hydronephrosis, including Gram stains performed by both trained physicians and microbiological technicians. Results After analyzing 210 patients, POC Gram stains of bladder urine presented a sensitivity, specificity, positive predictive value, and negative predictive value of 86.8%, 81.8%, 93.7%, and 66.7%, respectively, for gram-negative rods and 65.7%, 83.4%, 48.9%, and 91.0%, respectively, for gram-positive cocci. The agreement between POC Gram stains and urine culture was good for gram-negative rods, with a kappa (κ) coefficient of 0.637 and agreement rate of 85.6%, and moderate for gram-positive cocci, with a κ coefficient of 0.435 and agreement rate of 80%. The agreement between POC Gram stains and bladder urine culture results for gram-negative rods was higher in the mild hydronephrosis group (κ coefficient = 0.677) than in the severe hydronephrosis group (κ coefficient = 0.466). Discrepancies in Gram stain results between physicians and technicians were observed in 21 of 180 cases (11.7%). Conclusions POC Gram stains for gram-negative rods may be a useful diagnostic tool for obstructive pyelonephritis, particularly in cases of mild hydronephrosis.
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Affiliation(s)
- Satoshi Hayano
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Toshiya Hidaka
- Department of Clinical Laboratory, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Risako Tadakuma
- Department of Clinical Laboratory, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Masayuki Kashima
- Department of Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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Militaru A, Bulai CA, Ene C, Popescu RI, Cozma C, Mares C, Balacescu S, Moldoveanu C, Georgescu DA, Geavlete PA, Geavlete BF. Double J Stents and Reno-Ureteral Lithiasis: Dynamic Changes in Management during the COVID-19 Pandemic. Life (Basel) 2023; 13:2113. [PMID: 38004253 PMCID: PMC10672095 DOI: 10.3390/life13112113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To provide an evidence-based review of the use of ureteral stents in managing reno-ureteral lithiasis during the COVID-19 pandemic. MATERIALS AND METHODS A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the search query, we entered "ureteral stents" OR "double J stent" AND "renal colic" OR "ureteral obstruction" OR "reno-ureteral lithiasis" AND "COVID-19 Pandemic" OR "SARS-CoV-2 infection". RESULTS Patients with lithiasis should be categorized into low priority, intermediate priority, high priority, and emergency under the COVID-19 pandemic scenario to manage their delay and save resources, including healthcare professionals, beds, and ventilators. However, immediate interventions are necessary for individuals at risk of life-threatening septic complications. During the COVID-19 pandemic, the feasibility of conducting or resuming elective activity depended on local circumstances, the accessibility of beds and ventilators, and the execution of screening protocols. If lithiasis surgery is delayed, consequences and increased effort will be inevitable. It is possible that teleconsultation could help guide these patients and cut down on unnecessary visits and exposure. CONCLUSIONS COVID-19 has shifted treatment options for urinary stones, with ureteral stents being a safe, efficient, and cost-effective option for managing urolithiasis. Decompression is essential in emergency situations, while ureteral stents reduce the risk of infection and hospital visits.
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Affiliation(s)
- Adrian Militaru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Catalin Andrei Bulai
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Cosmin Ene
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Razvan Ionut Popescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri, 050659 Bucharest, Romania
| | - Cosmin Cozma
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Cristian Mares
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Stefan Balacescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Cristian Moldoveanu
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Dragos Adrian Georgescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Petrisor Aurelian Geavlete
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
| | - Bogdan Florin Geavlete
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari, 050474 Bucharest, Romania
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti, 042122 Bucharest, Romania
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Kamei J, Sugihara T, Yasunaga H, Matsui H, Sasabuchi Y, Fujimura T, Homma Y, Kume H. Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database. World J Urol 2023; 41:1365-1371. [PMID: 36947175 DOI: 10.1007/s00345-023-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The impact of early drainage on mortality in patients with obstructive pyelonephritis with urolithiasis was evaluated. METHODS We identified 34,924 patients in the Japanese Diagnosis Procedure Combination database with obstructive pyelonephritis with urolithiasis receiving ureteral drainage. The effects of early drainage (1-2 days) compared to those of delayed drainage (on 3-4 and ≥ 5 hospital days) on mortality were evaluated among 31,696 patients hospitalized for ≥ 5 days. Multivariate analysis was performed to identify independent factors for mortality. RESULTS The mortality rates for overall cases and those hospitalized for ≥ 5 days were 2.0% and 1.6%, respectively. Those receiving drainage on 1-2, 3-4, and ≥ 5 days had mortality rates of 1.5%, 2.0%, and 2.5%, respectively (p < 0.001). Multivariate analysis revealed that delayed drainage was an independent factor for higher mortality (odds ratio [OR] on days 3-4 and ≥ 5; 1.44, p = 0.018; and 1.69, p < 0.001). Increasing age (OR for 60 s, 70 s, and ≥ 80 years; 2.02, 3.85, and 7.77), Charlson comorbidity index score (OR, 1.41 by 1-point increase), disseminated intravascular coagulation (OR, 2.40), ambulance use (OR, 1.22), impaired consciousness at admission (disoriented, arousable with stimulation, and unarousable; OR 1.58, 2.84, and 5.50), and nephrostomy (OR, 1.65) were associated with higher mortality. In contrast, female sex (OR, 0.76) and high hospital volume (OR on 9-16, and ≥ 17 cases/year; 0.80, and 0.75) were associated with lower mortality. CONCLUSION Ureteral drainage within 2 hospital days was an independent factor for low mortality in obstructive pyelonephritis with urolithiasis. Delayed drainage could increase mortality in a time-dependent manner.
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Grants
- 20H03907 the Ministry of Education, Culture, Sports, Science, and Technology, Japan
- 21AA2007 the Ministry of Health, Labor, and Welfare, Japan
- 22AA2003 the Ministry of Health, Labor, and Welfare, Japan
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yukio Homma
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Mazzon G, Zhang X, Yang X, Cheng F, Liu Y, Zeng G. The effect of COVID-19 outbreak on urological procedures for urinary stones: data from three high-volumes centers in China. Urolithiasis 2022; 51:5. [PMID: 36454280 PMCID: PMC9713732 DOI: 10.1007/s00240-022-01390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
China has been the first country to be affected by the COVID-19 outbreak. The pandemic resulted in significant disruption of Health Care Services worldwide, and this effect on treatments for urinary stones is currently unclear. This is the first retrospective study involving three tertiary referral centers for urolithiasis across China. We evaluated surgical volumes and peri-operative outcomes of procedures delivered for upper urinary tract stones. We compared trimester prior to restrictions for COVID-19 (October 1st, 2019 to December 31st, 2019, period A), during restrictions (February 1st, 2020 to March 31st, 2020, period B), and afterword (April 1st, 2020 to June 31st, 2020, period C). A total of 2,543 procedures have been carried out. We observed a loss of 743 cases during period B (-29.2%) and 201 during period C (-7.9%). Percutaneous surgery showed the worst reduction, with 507 mini-PCNLs delivered in period A, 168 in period B (-60.8%), and 389 (-18.3%) in period C (p = 0.001). A worst trend was shown for standard PCNLs with 84 procedures carried out in period A, 5 in period B (-95.2%), and 9 (-89.2%) in period C (p = 0.001). Retrograde surgery also decreased, from 420 cases in period A to 190 cases in period B (-54.8%). An increment was however seen in period C when 468 cases have been carried out (+ 11.4%, p = 0.008). In term of SFRs, a difference was noticed for RIRSs, being 69.2%, 80.5%, and 69.3% during three periods (p = 0.045) and semirigid ureteroscopies (90.3%, 97.1%, and 84.8%, p = 0.013). Charlson's Comorbidity Score could not show any difference between groups as well as no differences in term of post-operative complications have been noticed.
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Affiliation(s)
- Giorgio Mazzon
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingguo Yang
- Department of Urology, Yiling Hospital, Yiling District, Yichang City, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yongda Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Lee J, Kottooran C, Hinojosa-González D, Yaghoubian A, Uppuluri N, Hanson K, Borofsky M, Eisner BH. Diabetes mellitus is associated with increased risk of positive qSOFA score but not with increased ICU admission in patients undergoing ureteral stent placement for ureteral stone and suspected infection. Can Urol Assoc J 2022; 16:430-434. [PMID: 36656692 PMCID: PMC9851227 DOI: 10.5489/cuaj.7896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Patients presenting with an obstructing ureteral stone and urinary tract infection (UTI) are at risk for severe infectious complications. Historically, diabetes mellitus (DM) was considered a risk factor for the development of septic shock in these patients. This study aimed to evaluate DM's impact on risk of septic shock in ureteral stent placement for ureteral stone and presumed UTI. METHODS An institutional review board-approved, retrospective review was performed at two institutions. All patients who met the following criteria from July 2016 to April 2020 were included in the study: emergency department visit with obstructing ureteral stone, concern for UTI, and ureteral stent placement. The primary outcome of interest was the development of postoperative septic shock defined by sepsis with hypotension requiring vasopressor support for at least one hour. RESULTS The study cohort was made up of 187 patients. Median age was 61 (range 16-91). Males represented 40.1% (n=75) of the population, while DM was present in 26.2% (n=49). Thirty-five of 143 patients (18.7%) met the criteria for postoperative septic shock. Quick Sequential Organ Failure Assessment (qSOFA) criteria were met by 11 (22.4%) patients with DM compared to 13 (9.5%) of patients without DM (p=0.026). This difference did not translate into significant differences in use of vasopressors, with DM cohorts requiring pressors in 11 (22.4%), and 241 (17.5%) in non-DM (p=0.523). Purulent urine was more frequently described in patients with DM (22 [44.9%] vs. 342 [4.8%], p=0.011). Intensive care unit (ICU) admissions were similar between DM and non-DM at 13(27.1%) vs. 29 (21.2%), respectively (p=0.543). ICU stay and length of stay were similar between cohorts. CONCLUSIONS In this multicenter study of patients who underwent ureteral stenting for ureteral stone and presumed UTI, DM was not associated with an increased risk of development of septic shock but was associated with an increased risk of positive qSOFA score.
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Affiliation(s)
- Jason Lee
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | - Christina Kottooran
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Alan Yaghoubian
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | - Nikkil Uppuluri
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Kate Hanson
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Micheal Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
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Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study. Diagnostics (Basel) 2021; 11:diagnostics11122277. [PMID: 34943514 PMCID: PMC8700712 DOI: 10.3390/diagnostics11122277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.
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Hsiao CY, Chen TH, Lee YC, Wang MC. Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection. Sci Rep 2021; 11:23333. [PMID: 34857804 PMCID: PMC8639828 DOI: 10.1038/s41598-021-02647-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022] Open
Abstract
To identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on AKI in patients with UTI. This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.299, 95% confidence interval [CI] 1.112–4.755, P = 0.025). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.451, 95% CI 1.369–4.389, P = 0.003) in UTI patients without hydronephrosis. The presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.
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Affiliation(s)
- Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Epidemiological and clinical characteristics of stone composition: a single-center retrospective study. Urolithiasis 2021; 50:37-46. [PMID: 34057535 DOI: 10.1007/s00240-021-01274-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
The aim of the study was to investigate the epidemiological characteristics of stone components in patients with urolithiasis and analyze the associations between stone components with patients' clinical characteristics. A total of 7126 patients with urolithiasis between July 2005 and June 2020 were retrospectively analyzed. In this research, calcium oxalate stones (74.6%) accounted for the highest proportion, followed by infection stones (11.8%), uric acid (10.6%), brushite (2.0%), and others (1.1%). The change in trend in the composition of urinary stones revealed that the proportion of uric acid declined steadily, while the content of infection stones increased gradually over 15 years. The results also suggested that stone composition was significantly associated with PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture (P < 0.05). However, there was no significant correlation between stone composition with smoking, WBC and NEU% (P > 0.05). Our study concluded that calcium oxalate represented the highest proportion, followed by infection stones, uric acid, brushite, and others. The proportion of uric acid declined steadily, while the infection stones increased gradually. Furthermore, the factors influencing the formation of urinary calculi are PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture. Collectively, these results may provide clues to establish effective prevention and management strategies for urinary calculi.
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Koch GE, Johnsen NV. The Diagnosis and Management of Life-threatening Urologic Infections. Urology 2021; 156:6-15. [PMID: 34015395 DOI: 10.1016/j.urology.2021.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
Genitourinary infections are commonly encountered and managed in inpatient, outpatient, and emergency settings. Fournier's gangrene, emphysematous pyelonephritis, and obstructive pyelonephritis represent the most serious urologic infections and have a high risk of mortality if not managed promptly. Due to the rarity of these infections, the evidence for specific treatment strategies is scattered. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of these life-threatening urologic infections.
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Affiliation(s)
- George E Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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10
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Chan HTC, Leung LY, Law AKK, Cheng CH, Graham CA. Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward. HONG KONG J EMERG ME 2021. [DOI: 10.1177/10249079211000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.
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Affiliation(s)
- Howard Tat Chun Chan
- Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Alex Kwok Keung Law
- Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Chi Hung Cheng
- Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Colin A Graham
- Accident and Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
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COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis. Int Urol Nephrol 2020; 53:627-633. [PMID: 33219920 PMCID: PMC7680071 DOI: 10.1007/s11255-020-02708-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022]
Abstract
Purpose Obstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID-19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center. Materials and methods After Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in “Pre-Covid” and “Post-Covid” groups based on the admission dates. Results A total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007). Conclusion During the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology.
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Lee SH, Choi T, Choi J, Yoo KH. Differences between Risk Factors for Sepsis and Septic Shock in Obstructive Urolithiasis. J Korean Med Sci 2020; 35:e359. [PMID: 33169555 PMCID: PMC7653168 DOI: 10.3346/jkms.2020.35.e359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/24/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Complicated acute pyelonephritis (APN) is a life-threatening condition that requires immediate intervention. This study examined the characteristics of APN occurring as a complication of ureteral stone. METHODS We retrospectively reviewed 85 patients diagnosed with APN complicated by ureteral stone between December 2006 and July 2017 at our institution. Patients with concomitant renal stone, multiple ureteral stones, ureteral strictures, ureteral cancer, and urogenital anomalies, including vesicoureteral reflux were excluded. Clinical characteristics including age, sex, underlying disease, medical history, stone characteristics, initial laboratory data, and the procedure used to correct urinary obstruction were summarized, and the risk factors associated with sepsis and septic shock were analyzed. RESULTS Sepsis was diagnosed at initial presentation in 62 patients, 17 of whom suffered from septic shock. Disease-related death did not occur in any patient. Previous history of stone (P = 0.015), leukocytosis (P < 0.001), elevated C-reactive protein levels (P = 0.006), and low albumin (P = 0.038) were significant risk factors for progression to sepsis. The absence of hypertension (P = 0.047), thrombocytopenia (P = 0.006), decreased erythrocyte sedimentation rate (ESR) (P = 0.003), elevated blood urea nitrogen (P = 0.016), and positive blood culture (P = 0.018) were significant predictors for progression to septic shock. Multivariate analysis revealed that previous history of stone (P = 0.015) was an independent risk factor for sepsis, while the absence of hypertension (P = 0.047), thrombocytopenia (P = 0.013), and decreased ESR (P = 0.009) were risk factors for shock. CONCLUSION The risk factors associated with the progression from APN to sepsis differed from those associated with the progression from sepsis to septic shock. Various factors should be considered while selecting treatment options based on the severity of APN associated with ureteral stone. It should be managed with aggressive treatment and close observation, especially in the presence of risk factors.
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Affiliation(s)
- Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Taesoo Choi
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jeonghyouk Choi
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
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Larkin S, Johnson J, Venkatesh T, Vetter J, Venkatesh R. Systemic inflammatory response syndrome in patients with acute obstructive upper tract urinary stone: a risk factor for urgent renal drainage and revisit to the emergency department. BMC Urol 2020; 20:77. [PMID: 32600324 PMCID: PMC7325089 DOI: 10.1186/s12894-020-00644-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/18/2020] [Indexed: 01/21/2023] Open
Abstract
Background In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit. Methods Retrospective review was performed of patients presenting to a tertiary academic emergency department (ED) from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. Data evaluated over a 3-year period included stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits. Results 1983 patients with urolithiasis were seen at the ED and 649 patients had obstructive urolithiasis on CT scan. SIRS was diagnosed in 15% (99/649) patients. 54/99 (55%) patients with SIRS underwent urgent renal drainage compared to 99/550 (17%) in non-SIRS patients. In a multivariate analysis SIRS was a predictor of urgent intervention compared to non-SIRS patients (odds ratio 4.6, p < 0.05). SIRS was also associated with increased risk for revisits to the ED (6.9% with SIRS vs. 2.4% with no SIRS, odds ratio 2.9, p = 0.05). Conclusions Presence of SIRS in obstructive urolithiasis patients was an independent risk factor of acute urologic intervention and revisits to the ED. A timely consultation with a urologist following discharge from ED for obstructive stone patients with SIRS who had no acute renal drainage may prevent revisit to the ED. Evaluation for SIRS in addition to other clinical risk factors should be considered while making management decision in patients with acute stone obstruction.
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Affiliation(s)
- Spencer Larkin
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Jeremy Johnson
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | | | - Joel Vetter
- Division of Urology Surgery, Washington University School of Medicine, 4960, Children's place, Campus Box 8242, St. Louis, MO, 63110, USA
| | - Ramakrishna Venkatesh
- Division of Urology Surgery, Washington University School of Medicine, 4960, Children's place, Campus Box 8242, St. Louis, MO, 63110, USA.
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Kozyrakis D, Kratiras Z, Soukias G, Chatzistamou SE, Zarkadas A, Perikleous S, Kateris D, Katsaros I, Skriapas K, Karagiannis D. Clinical Outcome and Prognostic Factors of Sepsis, Septic Shock and Prolonged Hospitalization, of Patients Presented with Acute Obstructive Pyelonephritis. J Endourol 2020; 34:516-522. [DOI: 10.1089/end.2019.0801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Zisis Kratiras
- Department of Urology, “Achillopoulio” General Hospital, Volos, Greece
| | - Georgios Soukias
- Department of Urology, “Achillopoulio” General Hospital, Volos, Greece
| | | | | | | | - Dimitris Kateris
- Department of Microbiology, “Achillopoulio” General Hospital, Volos, Greece
| | - Ilias Katsaros
- Department of Urology, “Achillopoulio” General Hospital, Volos, Greece
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Pandey S, Sankhwar SN, Goel A, Kumar M, Aggarwal A, Sharma D, Agarwal S, Pandey T. Quick Sequential (Sepsis Related) Organ Failure Assessment: A high performance rapid prognostication tool in patients having acute pyelonephritis with upper urinary tract calculi. Investig Clin Urol 2019; 60:120-126. [PMID: 30838345 PMCID: PMC6397933 DOI: 10.4111/icu.2019.60.2.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/06/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose To analyze the utility of quick Sequential Organ Failure Assessment (qSOFA) in patients with uro-sepsis due to acute pyelonephritis (APN) with upper urinary tract calculi, we conducted this study. The role of qSOFA as a tool for rapid prognostication in patients with sepsis is emerging. But there has been a great debate on its utility. Literature regarding utility of qSOFA in uro-sepsis is scarce. Materials and Methods Ours was a retrospective study including 162 consecutive patients who were admitted for APN with upper urinary tract calculi over a 3 and half years (total 42 months) period. We evaluated the accuracy of qSOFA in predicting inhospital mortality and intensive care unit (ICU) admissions and compared this with the predictive accuracy of systemic inflammatory response syndrome (SIRS). We used the Area Under Curve (AUC) of the Receiver Operator Characteristic curve to calculate it and also calculated the optimum cut off for qSOFA score. Results The overall mortality and ICU admission rates were 7.4% and 12.9%, respectively. qSOFA had a higher predictive accuracy for in-hospital mortality (AUC, 0.981; 95% confidence interval [CI], 0.962-1.000) and ICU admissions (AUC, 0.977; 95% CI, 0.955-0.999) than SIRS. A qSOFA score of ≥2 was an optimum cut off for predicting prognosis. In a multivariate model qSOFA ≥2 was a highly significant predictor of in-hospital mortality and ICU admissions (p<0.001). Conclusions qSOFA is a reliable and rapid bedside tool in patients with sepsis with accuracy more than SIRS in predicting inhospital mortality and ICU admissions.
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Affiliation(s)
- Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | | | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - Deepanshu Sharma
- Department of Urology, King George's Medical University, Lucknow, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - Tushar Pandey
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jennings CA, Khan Z, Sidhu P, Navarrete O, Palladino A, Rutland E, Villa JAC, Gonzalez LJ, Kalantari H, Hassen GW. Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage. Am J Emerg Med 2019; 37:1855-1859. [PMID: 30686535 DOI: 10.1016/j.ajem.2018.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/15/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. OBJECTIVES The aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use. METHODS The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed. RESULTS Of the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication. CONCLUSION Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.
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Affiliation(s)
| | - Zoya Khan
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Pardeep Sidhu
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Oralia Navarrete
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Ann Palladino
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Emily Rutland
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | | | - Leidy Johanna Gonzalez
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Hossein Kalantari
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America
| | - Getaw Worku Hassen
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America.
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17
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Fukushima H, Kobayashi M, Kawano K, Morimoto S. Performance of Quick Sequential (Sepsis Related) and Sequential (Sepsis Related) Organ Failure Assessment to Predict Mortality in Patients with Acute Pyelonephritis Associated with Upper Urinary Tract Calculi. J Urol 2018; 199:1526-1533. [DOI: 10.1016/j.juro.2017.12.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Masaki Kobayashi
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Keizo Kawano
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Shinji Morimoto
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Ruiz-Mesa JD, Marquez-Gomez I, Sena G, Buonaiuto VA, Ordoñez JM, Salido M, Ciézar AP, Santis LVD, Mediavilla C, Colmenero JD. Factors associated with severe sepsis or septic shock in complicated pyelonephritis. Medicine (Baltimore) 2017; 96:e8371. [PMID: 29069028 PMCID: PMC5671861 DOI: 10.1097/md.0000000000008371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Severe sepsis or septic shock are the main factors influencing the prognosis of acute pyelonephritis (APN). Our aim was to analyze factors associated with the development of severe sepsis or septic shock in a large sample of patients with acute complicated pyelonephritis (ACPN).This prospective observational study comprised 1507 consecutive patients aged 14 years or older who were admitted to a tertiary care hospital because of ACPN between 1997 and 2015. Covariates associated in univariate analysis with severe sepsis or septic shock were then analyzed by multivariate logistic regression.Of the 1507 patients, 423 (28.1%) fulfilled the criteria for severe sepsis or septic shock at the time of admission. Crude and attributable mortality at 30 days were 17.7% and 11.7% in patients with severe sepsis or septic shock versus 1.7% and 0.6% in patients without severe sepsis or septic shock, P < .0001 and P < .0005, respectively. An age > 65 years, urinary instrumentation in the previous 2 weeks, the lack of mictional syndrome or costovertebral tenderness, an ectasia ≥ grade II, and bacteremia were independent risk factors associated with severe sepsis or septic shock.The prevalence of severe sepsis and septic shock in patients with ACPN is high. Some factors associated with severe sepsis are easy to identify in any emergency department. The information provided here could be useful when deciding which patients should be admitted to receive immediate treatment.
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Affiliation(s)
- Juan D. Ruiz-Mesa
- Infectious Diseases Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Ignacio Marquez-Gomez
- Infectious Diseases Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Gabriel Sena
- Microbiology Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Veronica A. Buonaiuto
- Infectious Diseases Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Juan Mora Ordoñez
- Critical Care and Emergency Departments, Regional University Hospital
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Manuel Salido
- Critical Care and Emergency Departments, Regional University Hospital
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Antonio Plata Ciézar
- Infectious Diseases Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | | | - Concepción Mediavilla
- Microbiology Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
| | - Juan D. Colmenero
- Infectious Diseases Department
- Instituto de Investigación Biomedica de Málaga (IBIMA), Malaga, Spain
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19
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Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V. Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis. Pak J Med Sci 2016; 32:570-4. [PMID: 27375691 PMCID: PMC4928400 DOI: 10.12669/pjms.323.9938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.
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Affiliation(s)
- Selcuk Sahin
- Selcuk Sahin, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Berkan Resorlu
- Berkan Resorlu, Department of Urology, Ondokuz Mayis Univercity, Faculty of Medicine, Samsun, Turkey
| | - Mithat Eksi
- Mithat Eksi, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Bekir Aras
- Bekir Aras, Department of Urology, Dumlupinar Univercity, Faculty of Medicine, Kutahya, Turkey
| | - Arda Atar
- Arda Atar, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Tugcu
- Volkan Tugcu, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
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Khatami A, Rosengren K. Reduced time from diagnosis to stone-free status in patients with ureteral calculi. Int J Health Care Qual Assur 2016; 29:276-87. [PMID: 27120506 DOI: 10.1108/ijhcqa-03-2015-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to describe an improvement project and its effects on decreasing the time from diagnosis to treatment for patients with kidney stones and to reduce the negative effects related to untreated stones at one hospital in western Sweden. Design/methodology/approach - A quantitative descriptive study based on Nolan's improvement model was used. The quality improvement effects were evaluated using statistical process control. Findings - Extracorporeal shock wave lithotripsy treatment's positive effects within 48 hours were described as efficiency (decreased waiting time) from diagnosis to treatment, even if a re-treatment was necessary. The results also showed a reduction in the usage of percutaneous nephropyelostomies as a treatment option. Research limitations/implications - This study includes data from one department at one hospital in one country. Comparative data include the time from acute radiological examination to final treatment but not total re-treatments, complications or time to up following radiological examination. However, the study was performed over one year and analyzed data from medical records in a systematic way. Practical implications - This study may inspire measuring and developing routines from diagnosis to treatment for patients who are transferred within different departments at one hospital. Social implications - By measuring the working process, resource use within a healthcare organization could be visualized. Planning and co-operation at different managerial levels are key factors for success when improvement projects are performed. Originality/value - Studies in improvement projects considering ureteral or kidney stones are generally lacking; thus, this study is important for improving the care of patients with this diagnose.
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Affiliation(s)
- Annelie Khatami
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Rosengren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Kubota M, Kanno T, Nishiyama R, Okada T, Higashi Y, Yamada H. [A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS]. Nihon Hinyokika Gakkai Zasshi 2016; 107:21-27. [PMID: 28132987 DOI: 10.5980/jpnjurol.107.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
(Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status ≥3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.
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Affiliation(s)
- Masashi Kubota
- The Department of Urology, Ijinkai Takeda General Hospital
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23
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[TREATMENT OUTCOME OF OBSTRUCTIVE PYELONEPHRITIS DUE TO URETERAL CALCULI WITH DISSEMINATED INTRAVASCULAR COAGULOPATHY]. Nihon Hinyokika Gakkai Zasshi 2015; 106:163-71. [PMID: 26419073 DOI: 10.5980/jpnjurol.106.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Because obstructive pyelonephritis secondary to ureteral stones can easily cause sepsis and concomitant disseminated intravascular coagulation (DIC), it is a potentially lethal disease. However, the optimal treatment for such severe patients has yet to be established. In this study, we aimed at clarifying the effectiveness of emergent drainage and DIC treatments for patients with septic DIC due to obstructive pyelonephritis. In additon, we also evaluated the impact of recombinant human thrombomodullin (rTM) for severe patients with DIC. MATERIALS AND METHODS From September 2006 to May 2013, 31 patients with obstructive pyelonephritis secondary to ureteral stones who met the acute DIC criteria from the Japanese Association of Acute Medicine were treated at our institution. All patients received emergent drainage of urinary tract and anti-DIC treatment, as well as administration of antibiotics and adequate volume infusion. To evaluate the impact of rTM, patients received rTM were compared with those managed by other DIC therapeutic agents. RESULTS The mean patients' age was 73 years old, and 27 patients (87.1%) were in a state of septic shock. All patients, except for one patient (3.2%) who died 6 days after drainage, could recover from sepsis and comcomitant DIC. Interestingly, thrombocyte count, creatinine, and SOFA Score in rTM group were recovered faster than those in no rTM group (p = 0.017, 0.0038, and 0.0006, respectively). CONCLUSIONS These results indicate that most patients with DIC caused by obstractive pyelonephritis can be successfully managed by emergency drainage and anti-DIC treatment. In addition, rTM may be effective for the treatment of such severe patients by improving organ failure associated with disordered coagulation.
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Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection. BIOMED RESEARCH INTERNATIONAL 2015; 2015:717094. [PMID: 26380292 PMCID: PMC4561874 DOI: 10.1155/2015/717094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI). MATERIALS AND METHODS This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection. RESULTS Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129-5.628, P = 0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908-11.273, P = 0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610-5.561, P = 0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups. CONCLUSION This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.
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Shaw E, Benito N, Rodríguez-Baño J, Padilla B, Pintado V, Calbo E, Pallarés MA, Gozalo M, Ruiz-Garbajosa P, Horcajada JP. Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort. J Infect 2015; 70:247-54. [PMID: 25305497 DOI: 10.1016/j.jinf.2014.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
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Affiliation(s)
- Evelyn Shaw
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.
| | - Natividad Benito
- Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Belén Padilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Esther Calbo
- Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Mónica Gozalo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Buonaiuto VA, Marquez I, De Toro I, Joya C, Ruiz-Mesa JD, Seara R, Plata A, Sobrino B, Palop B, Colmenero JD. Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study. BMC Infect Dis 2014; 14:639. [PMID: 25492862 PMCID: PMC4267459 DOI: 10.1186/s12879-014-0639-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/18/2014] [Indexed: 11/23/2022] Open
Abstract
Background Complicated pyelonephritis (cPN), a common cause of hospital admission, is still a poorly-understood entity given the difficulty involved in its correct definition. The aim of this study was to analyze the main epidemiological, clinical, and microbiological characteristics of cPN and its prognosis in a large cohort of patients with cPN. Methods We conducted a prospective, observational study including 1325 consecutive patients older than 14 years diagnosed with cPN and admitted to a tertiary university hospital between 1997–2013. After analyzing the main demographic, clinical and microbiological data, covariates found to be associated with attributable mortality in univariate analysis were included in a multivariate logistic regression model. Results Of the 1325 patients, 689 (52%) were men and 636 (48%) women; median age 63 years, interquartile range [IQR] (46.5-73). Nine hundred and forty patients (70.9%) had functional or structural abnormalities in the urinary tract, 215 (16.2%) were immunocompromised, 152 (11.5%) had undergone a previous urinary tract instrumentation, and 196 (14.8%) had a long-term bladder catheter, nephrostomy tube or ureteral catheter. Urine culture was positive in 813 (67.7%) of the 1251 patients in whom it was done, and in the 1032 patients who had a blood culture, 366 (34%) had bacteraemia. Escherichia coli was the causative agent in 615 episodes (67%), Klebsiella spp in 73 (7.9%) and Proteus ssp in 61 (6.6%). Fourteen point one percent of GNB isolates were ESBL producers. In total, 343 patients (25.9%) developed severe sepsis and 165 (12.5%) septic shock. Crude mortality was 6.5% and attributable mortality was 4.1%. Multivariate analysis showed that an age >75 years (OR 2.77; 95% CI, 1.35-5.68), immunosuppression (OR 3.14; 95% CI, 1.47-6.70), and septic shock (OR 58.49; 95% CI, 26.6-128.5) were independently associated with attributable mortality. Conclusions cPN generates a high morbidity and mortality and likely a great consumption of healthcare resources. This study highlights the factors directly associated with mortality, though further studies are needed in the near future aimed at identifying subgroups of low-risk patients susceptible to outpatient management.
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Affiliation(s)
- Veronica A Buonaiuto
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Ignacio Marquez
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Inmaculada De Toro
- Microbiology Unit, Regional University Hospital, Malaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Carolina Joya
- Critical Care and Emergency Departments, Regional University Hospital, Malaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Juan D Ruiz-Mesa
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Raimundo Seara
- Critical Care and Emergency Departments, Regional University Hospital, Malaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Antonio Plata
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Beatriz Sobrino
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Begoña Palop
- Microbiology Unit, Regional University Hospital, Malaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
| | - Juan D Colmenero
- Infectious Diseases Department, Regional University Hospital, Málaga, Spain. .,IBIMA, Malaga University, Malaga, Spain.
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[Mortality predictive factors in patients with urinary sepsis associated to upper urinary tract calculi]. Med Intensiva 2014; 39:290-7. [PMID: 25444058 DOI: 10.1016/j.medin.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/05/2014] [Accepted: 07/14/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. DESIGN A retrospective observational study covering a 16-year period (2006-2011) was carried out. SETTING The combined clinical/surgical ICU of a secondary-level University hospital. PATIENTS All patients admitted to the ICU due to obstructive urinary sepsis. INTERVENTIONS None. MAIN VARIABLES We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. RESULTS A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality. CONCLUSIONS Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.
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Acute management of stones: When to treat or not to treat? World J Urol 2014; 33:203-11. [DOI: 10.1007/s00345-014-1353-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022] Open
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Nishiguchi S, Branch J, Suganami Y, Kitagawa I, Tokuda Y. Effectiveness of early ureteric stenting for urosepsis associated with urinary tract calculi. Intern Med 2014; 53:2205-10. [PMID: 25274231 DOI: 10.2169/internalmedicine.53.2617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Patients with urosepsis associated with urinary tract calculi occasionally require drainage, primarily via ureteric stenting. Such patients require longer hospitalization. However, the indications for early ureteric stenting for this condition have not been clearly defined. To compare the length of stay (LOS) in the hospital between patients treated with earlier ureteric stenting versus those with delayed ureteric stenting. METHODS Design: Retrospective cohort study. Setting: An acute care teaching hospital in Japan. MEASUREMENT Length of hospital stay in days. Patients Patients with urosepsis associated with urinary tract calculi. RESULTS Among a total of 30 patients (mean age, 72; 13 men), the mean number of days from emergency room admission to ureteric stenting was 3.5 days (range, 1-14 days), and the overall mean LOS was 36 days (range, 8-102 days). The early stenting group (mean LOS, 21 days) had a significantly shorter LOS than the delayed stenting group (mean LOS, 50 days), with an adjusted beta coefficient of -26 days [95% confidence interval (CI), -46, -6]. CONCLUSION In patients with urosepsis associated with urinary tract calculi, performing early stenting within two days of admission may reduce the LOS in the hospital.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
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Tambo M, Okegawa T, Shishido T, Higashihara E, Nutahara K. Predictors of septic shock in obstructive acute pyelonephritis. World J Urol 2013; 32:803-11. [PMID: 24037335 PMCID: PMC4031390 DOI: 10.1007/s00345-013-1166-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/02/2013] [Indexed: 12/20/2022] Open
Abstract
Purpose Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi. Methods We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis. Results Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock. Conclusion Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.
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Affiliation(s)
- Mitsuhiro Tambo
- Department of Urology, Kyorin University School of Medicine, 6-20-2, Shikawa, Mitaka, Tokyo, 181-8611, Japan,
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Kamei J, Nishimatsu H, Nakagawa T, Suzuki M, Fujimura T, Fukuhara H, Igawa Y, Kume H, Homma Y. Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract. Int Urol Nephrol 2013; 46:493-7. [PMID: 24006032 DOI: 10.1007/s11255-013-0545-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/16/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the risk factors for septic shock in patients with acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract. METHODS We retrospectively reviewed the records of 48 patients who underwent emergency drainage of the upper urinary tract for sepsis associated with acute obstructive pyelonephritis at our institute. Univariate and multivariate analyses were performed to identify the risk factors. RESULTS Among 54 events of sepsis, we identified 20 events of septic shock requiring vasopressor therapy. Cases with shock were more likely than those without shock to have ureteral stone (70 vs 38%, p = 0.024) and positive blood culture results (81 vs 28%, p = 0.006). They received drainage significantly earlier than those without shock (1.0 vs 3.5 days, p < 0.001). Univariate analysis demonstrated that acute obstructive pyelonephritis by ureteral stone, rapid progression (the occurrence of symptoms to drainage ≤ 1 day), positive blood culture, leukocytopenia (<4,000/mm(3)), thrombocytopenia (<120,000/mm(3)), and prothrombin time international normalized ratio ≥ 1.20 were correlated with septic shock. Multivariate logistic regression analysis identified thrombocytopenia (p = 0.005) and positive blood culture (p = 0.040) as independent risk factors for septic shock. CONCLUSIONS Thrombocytopenia and positive blood culture were independent risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage. Thrombocytopenia would be practically useful as a predictor of septic shock.
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Affiliation(s)
- Jun Kamei
- Department of Urology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Reply from Authors re: Brian R. Matlaga. How Do We Manage Infected, Obstructed Hydronephrosis? Eur Urol 2013;64:93–4. Eur Urol 2013; 64:95-6. [DOI: 10.1016/j.eururo.2012.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 10/31/2012] [Indexed: 11/23/2022]
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Chen X, Wang Y, Luo H, Luo Z, Liu L, Xu W, Zhang T, Yang N, Long X, Zhu N, Xie H, Liu J. Ulinastatin reduces urinary sepsis‑related inflammation by upregulating IL‑10 and downregulating TNF‑α levels. Mol Med Rep 2013; 8:29-34. [PMID: 23685622 DOI: 10.3892/mmr.2013.1480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/09/2013] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to determine the efficacy of ulinastatin (UTI) for the treatment of sepsis and to investigate the associated molecular mechanisms. Twenty‑four male rabbits were randomly divided into 4 groups, the normal, sham, sepsis model and UTI groups, each containing 6 rabbits. Serum levels of interleukin (IL)‑10 and tumor necrosis factor‑α (TNF‑α) were measured by enzyme‑linked immunosorbent assay (ELISA). Liver, kidney and lung tissues were stained with hematoxylin and eosin (H&E) 36 h after sacrifice and morphological changes were observed under an optical microscope. The expression levels of IL‑10 and TNF‑α proteins in rabbit kidney tissue in each group were determined by immunohistochemical detection and western blot analysis. ELISA results indicated that, compared with the sepsis model, IL‑10 levels were significantly higher in the UTI treatment group (183.91±11.521 pg/ml) at 36 h (P=0.000), while serum TNF‑α concentration decreased significantly in the UTI treatment group (31.637±2.770 pg/ml; P=0.000). Results of western blot analysis were consistent with the immunohistochemistry, indicating that UTI upregulates IL‑10 and downregulates TNF‑α levels. In the current study, UTI was demonstrated to effectively treat urinary sepsis and alleviate the inflammatory response in tissues. These effects were mediated by the upregulation of IL‑10 and downregulation of TNF‑α levels.
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Affiliation(s)
- Xian Chen
- Department of Urology, The Second Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China
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Nishiguchi S, Tokuda Y. Effectiveness of early ureteric stenting for urosepsis associated with urinary tract calculi. Crit Care 2013. [PMCID: PMC3642881 DOI: 10.1186/cc11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV. Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi. J Urol 2013; 189:946-51. [DOI: 10.1016/j.juro.2012.09.088] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Michael S. Borofsky
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - Dawn Walter
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - Ojas Shah
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - David S. Goldfarb
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - Adam C. Mues
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - Danil V. Makarov
- Department of Urology, Nephrology Division and Section on Value and Effectiveness, Department of Population Sciences, New York University Langone Medical Center, Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System and Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
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