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Objective To study the clinical features of complicated upper urinary tract infection in children,aiming to provide a reference for clinical diagnosis and treatment of the disease.Methods The clinical data of 68 cases with complicated upper urinary tract infection hospitalized at the Department of Urinary Surgery NO.1,Children's Hospital of Shenzhen between January 2013 and August 2015 were retrospectively analyzed.Results A total of 68 cases,in which 44 were male,24 were female,and repeated infections were found in 15 cases.Fever was the most common clinical manifestation(48 cases,70.59％),while frequent urination and odynuria were rare(9 cases,13.24％).A total of 57 strains had been cultured form the submitted specimens which were obtained from the 68 cases,including 41 strains of gram-negative bacteria,15 strains of gram-positive bacteria and 1 strain of fungus.Two different strains were cultured in 3 children.Fourteen strains of Escherichia coli had 11 extended spectrum beta lactamases (ESBLs)-positive strains.In the 11 strains of klebsiella pneumoniae,8 trains were ESBLs-positive.The drug resistant rates of gram-negative bacteria to Ampicillin and Cefuroxime sodium were both more than 90％.The sensitive rates to Piperacillin/Tazobactam was more than 90％.Thirty-one cases of complicated upper urinary tract infection were cured by administering Piperacillin/Tazobactam,while 15 cases were cured by changing Cefuroxime sodium to Piperacillin/Tazobactam according to the drug sensitivity results.Conclusions Clinical manifestations of complicated upper urinary tract infection are untypical,and fever is the most common symptom.Repeated infection is common.The gram-negative bacteria is the dominant pathogen causing the complicated upper urinary tract infection.ESBLs-positive bacteria accounts for high proportion.The drug resistance rate to penicillin and the first,second generation of the cephalosporin is high.The drug sensitive rate of piperacillin tazobactam is high,with good prognosis.
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Spontaneous renal hemorrhage is an unusual complication of urinary tract infection. A 56-year-old man, diabetic with single functional kidney was admitted with fever and abdominal pain for one day. He had pyuria and an obstructed renal moiety due to a lower ureteric stone. On evaluation, he was found to have a left perirenal hemorrhage. Drainage of the obstructed system was performed and hemorrhage was managed conservatively; in the postoperative period patient remained stable and was discharged. In conclusion, complicated urinary tract infection is a rare cause of the spontaneous perirenal hematoma and needs a high vigilance for diagnosis and management.
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Background & objectives: Carbapenem resistance mediated by carbapenemases is increasingly being reported worldwide. This study was conducted to know the occurrence of important carbapenem resistance encoding genes in gram-negative bacilli (GNB) causing complicated urinary tract infection (CUTI), and to look at the genetic diversity of these isolates. Methods: The study was carried out on 166 consecutive carbapenem resistant uropathogens (CRU) isolated from cases with CUTI during 2008 and 2012. Carbapenemase production was characterized phenotypically and polymerase chain reaction was used to detect blaVIM, blaIMP, blaKPC, and blaNDM-1. BOX- PCR was done on 80 randomly selected isolates for molecular typing. Results: The blaVIM gene was present in 34 (43.6%), blaIMP in five (6.4%) and none of the isolates from 2008 had blaNDM-1 or blaKPC genes. Among the isolates from 2012, blaNDM-1 gene was present in 47 (53.4%), blaVIM in 19 (24.4%), blaIMP in one (1.1%) and none had blaKPC. There were nine isolates during the two years which had multiple genes encoding carbapenemases; while 66 did not have any of the genes tested. Of the 80 isolates subjected to BOX-PCR, 58 could be used for analysis and showed, presence of multiple clusters of carbapenem resistant isolates and absence of a single dominant clone. Interpretation & conclusions: The blaNDM-1 gene was absent in our isolates obtained during 2008 but was present amongst Enterobacteriaceae isolated in 2012. The blaKPC gene was also not found. Nine isolates obtained during the two years had multiple genes encoding carbapenemases confirming the previous reports of emergence of GNB containing genes encoding multiple carbapenemases. Typing using BOX-PCR indicated that this emergence was not because of clonal expansion of a single strain, and multiple strains were circulating at a single point of time.
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Objective To investigate the distribution and antibiotic resistance patterns of uropathogens in children with complicated urinary tract infection to guide the empirical antimicrobial treatment.Methods Retrospective analysis of isolated bacteria from 141 children hospitalized with complicated urinary tract infection was performed from January 2011 to January 2013.Results Gram-negative bacillus were the main pathogens [56.6％(81/143)],and Escherichia coli was the leading cause (41.3％,59/143).Gram-positive bacillus accounted for 38.5％ (55/143),including Enterococcus faecium (17.5％,25/143) and Enterococcus faecalis (14.7％,21/143).Fungi caused 4.9％ (7/143) of the infections.The resistance of Escherichia coli to amoxicillin was the highest [92.0％ (23/25)] and resistance to imipenem (4.3％,2/47),amikacin (6.8％,4/59) and nitrofurantoin (6.8％,4/59) was lower.It was observed resistance of Enterococcus faecium to linezolid,quinupristin,vancomycin and nitrofurantoin was significantly lower than other common antibiotics.The resistance of Enterococcus faecalis to quinupristin,tetracycline,erythromycin,rifampicin was significantly higher than other common antibiotics.Concluusions Escherichia coli,Enterococcus faecium and Enterococcus faecalis are the common uropathogens.These pathogens have a high antibiotic resistance to many common antibiotics.The selection of empirical treatment of children with complicated urinary tract infection should be adjusted by antimicrobial susceptibility test.
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The present report describes the case of a 22-year-old female patient admitted to the emergency room with acute low back pain, dysuria, vomiting and fever (38.5ºC). Urinalysis and computed tomography findings revealed urinary tract infection associated with presence of gas in the collecting system, characterizing unilateral emphysematous pyelitis caused by Gram-negative bacteria. The present case report emphasizes the occurrence of this disease as a urinary tract infection complication.
Relata-se um caso de paciente de 22 anos de idade, gênero feminino, que foi admitida no pronto-socorro com lombalgia aguda, disúria, vômitos e febre (38,5ºC). Os achados de exames de urina e tomografia computadorizada demonstraram infecção no trato urinário associada a gás no sistema coletor, configurando pielite enfisematosa unilateral por Gram-negativo. O presente relato enfatiza a ocorrência deste agravo como complicação de infecção no trato urinário.
Subject(s)
Humans , Female , Young Adult , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Pyelitis/diagnosis , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE To evaluate the efficacy and safety of teicoplanin treatment on complicated Gram-positive urinary tract infection.METHODS The patients′ clinical manifestation,laboratory results,bacterial culture changes after intravascular administration of teicoplanin were observed.Each patient was administered teicoplanin(200 mg once a day for 10-14 days,but 400 mg in the first day).RESULTS The effective rate and the bacterial eradication rate were 90.0% and 86.7%,respectively.All patients experienced relief from clinical infective symptoms and systemic reactions.There were no abnormal laboratory findings and adverse reactions.CONCLUSIONS Teicoplanin is an effective and safe antibiotic for the treatment of patients with complicated urinary tract infection.