The diagnosis and management of a patient with acute pyelonephritis

Aerococcus viridans pyelonephritis in a young age female patient with type 1 diabetes mellitus: a rare case report

Background

Aerococcus species are Gram-positive cocci, with negative catalase and oxidase activities and growth characteristics similar to viridans streptococci. They rarely cause infection in humans. However, there are reports of bacteremia, meningitis, septic arthritis, and endocarditis due to this pathogen in the literature. Herein we report a rare case of pyelonephritis due to A. viridans.

Case presentation

A 31-year-old-female patient with type 1 diabetes mellitus was presented with left loin pain, fever, nausea, and anorexia for 3 days. She had a history of obstructive nephropathy due to sloughed necrotic papillae 3 months earlier, mandating bilateral JJ stent insertion. She was treated with a 2 weeks course of doxycycline (100 mg, twice daily) based on the antibiotic susceptibility profile of her urine culture and responded well.

Conclusion

This case highlights the possibility of complicated urinary tracts infection due to a rare human pathogen.

The Model of Acute Obstructive Pyelonephritis for Studying Bacterial Translocation of E. coli from Gastroenteric Tract

BACKGROUND: The role of intestinal microflora translocation in the development of obstructive pyelonephritis has not been sufficiently studied. The urgency to develop a new model of acute obstructive pyelonephritis is due to the search for characteristics that are able to meet the criteria for reproducibility of microbial translocation from the intestine, the reversibility of the stages of the inflammatory process with further observation in the dynamics of development. AIM: The aim of the given research is to develop a model of acute obstructive pyelonephritis to study the pathogenetic role of bacterial translocation of Escherichia coli (hereinafter E. coli) from the gastrointestinal tract (GIT). METHODS: Twenty outbred male rabbits aged 3 months and weighing 3.0 ± 0.5 kg were used for the research. All the animals were randomly divided into two groups: Experimental (n = 10) and control (n = 10). In the experimental group, obstructive pyelonephritis was modeled by ligating the external opening of the urethra and injecting an antibiotic-resistant E. coli strain into the GIT using enteric capsules. In the control group, the strain was administered in the same way, but without forming a model of obstructive pyelonephritis. The animals were withdrawn from the experiment on the 3rd day by air embolism under general anesthesia. In both groups, the sizes of the kidney, pelvis, ureter, and the number of leukocytes in urine were assessed. RESULTS: In the experimental group, there was an increase in the size of the kidney, pelvis, as well as ureter with some pronounced leukocyturia observed, which indicates the development of obstructive pyelonephritis. In the control group, only one animal had leukocyturia. The statistically significant differences were revealed between the groups in all studied parameters. CONCLUSION: The results of this research demonstrated that the proposed model provided an opportunity to study the role of intestinal translocation of microorganisms in the development of acute obstructive pyelonephritis.

Catheterization Does Not Improve Course of Disease in Female Patients with Acute Cystitis or Pyelonephritis: Retrospective Analysis of >300 In-Hospital Treated Patients

PURPOSE

Females with in-hospital treatment for acute cystitis (AC) or pyelonephritis may benefit from catheterization at admission.

METHODS

All female patients with AC or pyelonephritis requiring in-hospital treatment at University Hospital Frankfurt (2004-2019) were retrospectively analyzed. Logistic regression models were used to predict the catheter value.

RESULTS

Of 310 female patients, 40% harbored AC versus 60% pyelonephritis, of whom 62% and 74% received a catheter at admission: C-reactive protein (CRP) and white blood count (WBC) were significantly elevated in AC and pyelonephritis catheter versus no catheter patients (both p < 0.05). Time to CRP and WBC nadir did not differ between the AC catheter versus no catheter group (both p > 0.05). Conversely, time to CRP nadir was prolonged in pyelonephritis catheter patients. AC and pyelonephritis catheter patients exhibited a prolonged antibiotic treatment and length of stay (LOS, both p < 0.05). In multivariable analyses, CRP >5 ng/mL was a predictor for receiving a catheter in all patients. In AC, a positive urine culture and fever predicted, respectively, prolonged LOS or antibiotic treatment (all p < 0.05).

CONCLUSION

Risk factors exist with regard to receiving a catheter and prolonged antibiotic treatment or LOS in females with AC or pyelonephritis. A catheter may not accelerate recovery or WBC nadir.

Pathogenic Mechanisms of Acute Obstructive Pyelonephritis

Among urological diseases, the most relevant is infection of the urinary tract. Pyelonephritis is on the 5th place in kidney diseases, and obstructive pyelonephritis occurs in 84% of all pyelonephritis. In the world, among the adult population, 100 people per 100,000 of the population suffer from pyelonephritis. In addition, from year to year, there is an increase in purulent forms of acute pyelonephritis by 4–5 times. This pathology is a separated manifestation of such an important urological problem as complicated urinary tract infection, which accounts for 84–86% of all infections. In acute obstructive pyelonephritis, more severe complications such as bacteriotoxic shock and urosepsis may develop. The mortality rate from these dangerous complications reaches 70–90%. In addition, the number of patients with urosepsis and bacteriotoxic shock has increased 4–6 times in recent years. The review presents current literature data on acute obstructive pyelonephritis. The main causes and pathogenetic mechanisms of the disease development are presented.