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Abstract
INTRODUCTION To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie. METHODS We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home). RESULTS From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women. CONCLUSION In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.
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Affiliation(s)
- R Boissier
- Université Aix-Marseille, Service d'Urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| | - P H Savoie
- Service d'urologie, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, France
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Seizilles de Mazancourt E, Vallée M, Sotto A, Le Goux C, Dihn A, Therby A, Boissier R, Savoie PH, Long JA, Bruyere F. [Infectious emergencies in urology]. Prog Urol 2021; 31:978-986. [PMID: 34420878 DOI: 10.1016/j.purol.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology. MATERIAL AND METHODS Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies. RESULTS Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection. CONCLUSION Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.
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Affiliation(s)
- E Seizilles de Mazancourt
- Service d'urologie et de la transplantation, Hôpital Édouard-Herriot, hospices civils de Lyon, 69008 Lyon, France
| | - M Vallée
- Service d'urologie, CHRU Poitiers, 86000 Poitiers, France
| | - A Sotto
- Service de maladies infectieuses, CHU Nîmes, 30000 Nîmes, France
| | - C Le Goux
- Centre Alfred-Kastler, Hôpital privé Nord parisien, 95200 Sarcelles, France
| | - A Dihn
- Service de maladies infectieuses, CHU Garches, 92380 France
| | - A Therby
- Service de maladies infectieuses, CH Versailles, 78150 France
| | - R Boissier
- Hopital de la conception, Assistance publique Hôpitaux de Marseille, 13005, France
| | - P H Savoie
- Hôpital d'Instruction des Armées Saint-Anne, BP 600, 83190 Toulon cedex 09
| | - J A Long
- Service d'urologie, Centre hospitalier universitaire de Grenoble, 38000 France; TIMC-IMAG, CNRS 5525, France
| | - F Bruyere
- Service d'urologie, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Bey E, Bouiller K, Pimpie R, Le Goux C, Tourret-Arnaud J, Lina G, Figueiredo S, Chauvin A, Gavazzi G, Malavaud S, Sotto A, Vallée M, Bruyère F. Recommendations of the AFU Infectious Diseases Committee on the prevention, diagnosis and treatment of infections of endo-ureteral equipment. Prog Urol 2021; 31:557-75. [PMID: 34154957 DOI: 10.1016/j.purol.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/06/2020] [Accepted: 02/11/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION No recent national guidelines exist regarding the management of urinary tract infections (UTIs) in the presence of ureteral stent. This situation could lead to discrepancies in clinical management and less opportunity for a favorable patient's outcome. METHODS All available data published on Medline® between 1998 and 2018 were systematically searched and reviewed. All papers assessing adult patients carrying ureteral stent were included for analysis. After studies critical analysis, national guidelines for clinical management were elaborated in order to answer clinical questions. RESULTS A total of 451 articles were identified, of which 58 have been included. The prevalence of urinary tract infections in the presence of ureteral stent remains unknown. After 3 months, all endo-ureteral devices were colonized on microbiological study. These patients also presented a positive urine culture in 25 to 70% of the cases, often polymicrobial. Staphylococci, E. coli, Klebsiella, Pseudomonas, Enterococcus and Candida were the commonest micro-organisms responsible for urinary colonization or infection. The risk of UTI on endo-ureteral devices seemed higher the longer it stayed implanted. There is no justification in the literature to recommend a systematic change of endo-ureteral devices following a urinary tract infection. DISCUSSION The existing literature is rich but of poor methodological quality, and therefore does not allow to draw robust conclusions. The greatest difficulty faced in this work was to accurately differentiate urinary colonizations from true infections, including clinical symptoms and not only microbiological results. CONCLUSION These guidelines propose a standardized management of such common clinical situations. Well-designed studies are needed to upgrade the level of evidence of these guidelines.
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Charlier C, Dang J, Woerther PL. In-hospital management of acute complicated urinary tract infections. Nephrol Ther 2019; 15 Suppl 1:S27-S32. [PMID: 30981392 DOI: 10.1016/j.nephro.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
Upper tract urinary tract infections that require hospitalization have been the focus of national recommendations in 2018 by the French society of infectious diseases (Spilf). We here propose to discuss several complex-challenging situations: severe infection with sepsis, pyelonephritis in the pregnant woman, management of infections involving multiresistant bacteria and infection in polycystic kidney disease.
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Affiliation(s)
- Caroline Charlier
- Université de Paris, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France; Service de maladies infectieuses et tropicales, centre hospitalier universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Centre national de référence, centre collaborateur OMS Listeria, Institut Pasteur, 25-28, rue du Docteur- Roux, 75724 Paris, France; Inserm U1117, unité de biologie des infections, 28, rue du Docteur-Roux, 75724 Paris cedex 15, France.
| | - Julien Dang
- Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Service de néphrologie, centre hospitalier universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Paul-Louis Woerther
- Unité de bactériologie, groupe hospitalier Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est-Créteil-Val-de-Marne, avenue du Général-de-Gaulle, 94010 Créteil cedex, France
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Gauthier S, Tattevin P, Soulat L, Bouget J, Abergel S, Hascoet J, Mathieu R, Beuzit L, Myhie D, Revest M, Bensalah K, Peyronnet B. Pain intensity and imaging at the initial phase of acute pyelonephritis. Med Mal Infect 2019; 50:507-514. [PMID: 31387815 DOI: 10.1016/j.medmal.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/12/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years. METHODS We performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed. Only patients who underwent an imaging study at the emergency department and with microbiologically confirmed pyelonephritis were included for analysis. The primary endpoint was the presence of urological complications on imaging findings. The secondary endpoint was treatment changes after imaging diagnosis. RESULTS Of the 193 women enrolled, 88 (45.6%) had urological complication(s) on imaging findings. The multivariate analysis revealed that history of urolithiasis (OR=2.41; P=0.01) and pain requiring morphine use (OR=5.29; P=0.009) were predictive of urological complications on imaging findings. Of the 120 women with uncomplicated pyelonephritis who underwent imaging studies, 45% had urological complication, resulting in a treatment change in 36.7% of patients. The multivariate analysis revealed that age>40 years (OR=4.58; P=0.02) and pain requiring morphine use (OR=3.78; P=0.02) were predictive of urological complication(s) on imaging findings and of treatment change based on imaging findings (OR=6.76; P=0.005 and OR=4.19; P=0.01 respectively) in this subgroup. CONCLUSIONS Pain requiring morphine use, age, and history of urolithiasis are independent predictors of urological complications on imaging findings in patients with acute pyelonephritis.
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Affiliation(s)
- S Gauthier
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France.
| | - P Tattevin
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - L Soulat
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Bouget
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - S Abergel
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Hascoet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - R Mathieu
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - L Beuzit
- Service de radiologie, université de Rennes 1, 35000 Rennes, France
| | - D Myhie
- Département de médecine générale, université de Rennes 1, 35000 Rennes, France
| | - M Revest
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - B Peyronnet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
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Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect 2018; 48:327-358. [PMID: 29759852 DOI: 10.1016/j.medmal.2018.03.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/24/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- F Caron
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France
| | - T Galperine
- Infection Control Program, Geneva University Hospitals, Switzerland
| | - C Flateau
- Immunologie clinique et maladies infectieuses, centre hospitalier Henri-Mondor, 94000 Créteil, France
| | - R Azria
- Cabinet de médecine générale, 95510 Vetheuil, France
| | - S Bonacorsi
- Service de microbiologie, hôpital Robert-Debré, université Paris Diderot, AP-HP, 75019 Paris, France
| | - F Bruyère
- Urologie, CHU deTours, 37000 Tours, France
| | - G Cariou
- Urologie, centre hospitaler Diaconesses, 75012 Paris, France
| | - E Clouqueur
- Gynécologie, CHRU de Lille, 59000 Lille, France
| | - R Cohen
- Néonatologie, centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - T Doco-Lecompte
- Maladies infectieuses, hôpitaux universitaires de Genève, Genève, Switzerland
| | - E Elefant
- Centre de référence sur les agents tératogènes, hôpital Armand-Trousseau, Groupe hospitalier Est, AP-HP, 75012 Paris, France
| | - K Faure
- Maladies infectieuses, CHRU de Lille, 59000, France
| | - R Gauzit
- Réanimation, CHU de Cochin, AP-HP, 75014 Paris, France
| | - G Gavazzi
- Clinique de médecine gériatrique, CHU de Grenoble-Alpes, 38700 La Tronche, France
| | - L Lemaitre
- Radiologie, CHRU de Lille, 59000 Lille, France
| | - J Raymond
- Microbiologie, université Paris Descartes, CHU de Cochin, 75014 Paris, France
| | - E Senneville
- Maladies infectieuses, CHRU de Lille, 59000 Lille, France
| | - A Sotto
- Maladies infectieuses, hôpital universitaire Carémeau, 30000 Nîmes, France
| | - D Subtil
- Gynécologie-obstétrique, CHRU Lille, 59000 Lille, France
| | - C Trivalle
- Gérontologie, hôpital Paul-Brousse, 94800 Villejuif, France
| | - A Merens
- Microbiologie, hôpital Inter-armées Begin, 94160 Saint-Mandé, France
| | - M Etienne
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France.
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Encatassamy F, Valentin AS, Capsec J, Buchler M, Bruyère F. Colonization of preservation solution in kidney transplantation: Clinical impact and risk of secondary acute graft pyelonephritis. Prog Urol 2018; 28:322-8. [PMID: 29395835 DOI: 10.1016/j.purol.2017.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 11/27/2017] [Accepted: 12/31/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Bacterial colonization of preservative solutions (PS) remains poorly described in renal transplantation. We investigated the bacterial colonization of the PS and its influence on graft pyelonephritis within one year from the renal transplantation. PATIENTS AND METHODS We cultured 2 samples of PS from 424 patients who underwent a renal transplantation. The follow-up period was one year. An acute graft pyelonephritis was defined as a positive bacteriological urine analysis, with temperature higher than 38.5°C or graft pain. RESULTS In total, 424 samples of PS were tested and 195 were positive for colonization (46%). Forty-five patients developed an acute graft pyelonephritis during the follow-up period (10.6%), of which, 21 (46.7%) showed a colonization of their PS. Twenty-four had no colonization (53.3%). This difference was not significant (P=0.697). DISCUSSION Our data suggest that the bacterial colonization of PS samples does not seem to increase the risk of acute graft pyelonephritis in renal transplant recipients. LEVEL OF EVIDENCE -3.
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Alezra E, Lasselin J, Forzini T, François T, Viart L, Saint F. [Prognostic factors for severe infection after flexible ureteroscopy: Clinical interest of urine culture the day before surgery?]. Prog Urol 2015; 26:65-71. [PMID: 26482456 DOI: 10.1016/j.purol.2015.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/22/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objectives of this study have been to determine prognostic factors for acute pyelonephritis (AP) after flexible ureteroscopy (FU), to assess the frequency of readmission for AP and to study the usefulness of urinalysis the day before surgery. METHODS Between 2010 and 2013, 266 patients have had at least one ureteroscopy (n=325). All infectious complications and unplanned readmissions within the month after FU were retrospectively evaluated. Several data have been collected: age, sex, BMI, surgical indication (calculis or tumor), number of previous ureteroscopies, number of previous surgeries for calculis, stones number, size and location, bilateral interventions, operating time, preoperative ureteral stenting, postoperative stenting, hospitalization stay, urine culture the day before surgery (j-1) and prescription of antibiotic therapy the week before FU. Correlation between these variables and acute pyelonephritis (AP) the month following the USSR was tested (StatView 4.5, SAS Institute) (P<0.05 significant). RESULTS We observed 24 postoperative APs (7.4%), 17 prior to hospital discharge and 7 requiring rehospitalization. In univariate analysis, the significant prognostic factors of postoperative AP have been: stone size (>14 mm) (P=0.03); operating time (70 minutes) (P<0.005); positive day - 1 urine culture (P<0.001); antibiotics treatment the week before FU (P<0.001). In multivariate analysis, antibiotics prescription during the week before USSR remained significant (P<0.002; RR 5.8 [1.9-15]). CONCLUSION Acute pyelonephritis requiring unplanned admission after ureteroscopy is a rare complication (2.4%). Urinalysis one day before ureteroscopy could allow early antibiotic therapy and may reduce 63% of unplanned hospital admissions for acute pyelonephritis. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- E Alezra
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France.
| | - J Lasselin
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France
| | - T Forzini
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
| | - T François
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France
| | - L Viart
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; Laboratoire d'anatomie et d'organogénèse, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
| | - F Saint
- HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France; Biobanque de Picardie, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France
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Bruyère F, Vidoni M, Péan Y, Ruimy JA, Elfassi R. [Bacteriological analysis of more than 600 febrile urinary infections managed in a community health network]. Prog Urol 2013; 23:890-8. [PMID: 24034802 DOI: 10.1016/j.purol.2013.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 03/04/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED Community-acquired febrile urinary tract infections (UTI) in adult has received little attention in the literature. The objective of our study was to determinate the distribution of bacterial strains isolated from adults with community-acquired febrile UTI and antibiotic susceptibility patterns of Escherichia coli. PATIENTS AND METHOD We studied the SPHERES's databank. SPHERES is a Parisian medical community network aimed at securing and facilitating the ambulatory management of potentially serious acute illnesses. Each patient is included in the network according to specific clinical criteria and standardized medical data are recorded. We retrospectively studied the medical records of all patients treated for a pyelonephritis or a prostatitis between April 2005 and October 2008. RESULTS Five hundred and sixty-eight patients were enrolled: 410 women and 158 men. The overall bacteria's distribution was similar to that observed in previous strictly microbiological studies with a more prominent role of E. coli (87.5%) to the detriment of other species. The overall susceptibility of E. coli to antibiotics recommended in the empiric treatment of pyelonephritis and prostatitis was preserved: ciprofloxacin (95.8%), cefotaxime (98%), gentamicin (99.4%). In women over 65 years, the susceptibility of E. coli to systemic fluoroquinolones fell up 89.7%. This could affect the empiric oral treatment of pyelonephritis in older women. CONCLUSIONS We report the bacterial distribution and the resistance pattern of bacteria implicated in febrile urinary infections diagnosed and treated in a health network. It seems that E. coli resistance increased more in women more than 65 years than in men.
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Affiliation(s)
- F Bruyère
- Service d'urologie, CHRU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France; Université François-Rabelais, PRES centre Val-de-Loire, 37044 Tours, France.
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