Abscesos renales: experiencia en un hospital pediátrico de referencia

Introducción: El absceso renal es infrecuente en pediatría, con clínica y laboratorio inespecíficos. Ante su sospecha, es necesario realizar imágenes para establecer diagnóstico. Objetivo: Describir las características clínico-epidemiológicas, microbiológicas, diagnósticas y terapéuticas de abscesos renales en pediatría. Pacientes y Métodos: Estudio retrospectivo, descriptivo, de pacientes internados con absceso renal, en seguimiento por Infectología del Hospital de Niños Ricardo Gutiérrez, durante 9 años. Resultados: 15 pacientes (67% varones), mediana de edad 9 años (rango [r] 0,7-17). Cuatro pacientes con comorbilidades. El síntoma más frecuente fue fiebre seguido por dolor lumbar. El recuento medio de leucocitos en sangre fue de 15.700/mm3 (r: 7.100-45.000) y la PCR de 193 mg/L (r: 1-362). Cuatro pacientes presentaron urocultivo positivo: dos Escherichia coli, uno Klebsiella pneumoniae y E. coli y otro Candida albicans y K. pneumoniae. Ningún paciente presentó bacteriemia. El diagnóstico se confirmó por ecografía. Se realizó drenaje en siete pacientes, con aislamiento de Staphylococcus aureus en dos y Pseudomonas aeruginosa en uno. El tratamiento incluyó terapia combinada en 67%. Mediana de antibioterapia intravenosa fue 16 días (r: 7-49), total de 28 (r: 14-91). Un paciente requirió terapia intensiva y dos, nefrectomía. Conclusión: Los abscesos renales son infrecuentes, con gran morbimortalidad. Sospechar en paciente con infección del tracto urinario (ITU) de evolución tórpida que persiste febril. En nuestro estudio, la alta sensibilidad de la ecografía renal permitió su diagnóstico precoz.

Background: Renal abscesses are infrequent in pediatrics, with nonspecific clinical and laboratory findings. When suspected, imaging is essential to establish the diagnosis. Aim: To describe the clinical-epidemiological, microbiological, diagnostic and therapeutic characteristics of renal abscesses in pediatrics. Methods: Retrospective and descriptive study of hospitalized patients with renal abscess, followed by Infectious Diseases Department of Ricardo Gutiérrez Children's Hospital during 9 years. Statistical analysis: Epi Info 7.2.2.6. Results: 15 patients (67% male), median age 9 years (range [r] 0.7-17) were included. Four patients had underlying disease. The most frequent symptom was fever, with a median duration of 10 days (r:1-36), followed by lumbar pain. The median white blood cell count was 15,700/mm3 (r: 7,100-45,000) and CRP 193mg/L (r: 1-362). Four patients presented positive urine culture: 2 Escherichia coli, 1 Klebsiella pneumoniae and E. coli and 1 Candida albicans and K. pneumoniae. No patient had bacteremia. The diagnosis of abscess was confirmed by ultrasound. Surgical drainage was performed in 7 patients, with isolation of Staphylococcus aureus in 2 and Pseudomonas aeruginosa in 1. Empirical treatment included 3rd generation cephalosporin, combined in 67% of cases. The median of intravenous antibiotic therapy was 16 days (r: 7-49) with a total of 28 days (r:14-91). One patient required transfer to intensive care unit and 2 nephrectomy. Conclusion: Renal abscesses are infrecuent in pediatrics, but they present significant morbidity and mortality. It should be suspected in patients with urinary tract infection (UTI)with torpid evolution that persists with fever without antibiotic response. In our study, the high sensitivity of renal ultrasound allowed early diagnosis.

Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

Absceso renal en pediatría: reporte de 2 casos / Kidney abscess in pediatrics: 2 case reports / Abscesso renal em pediatria: relato de dois casos

Resumen Introducción. Los abscesos renales tras una infección urinaria en pediatría no son frecuentes. Reporte de los casos. Se trata de dos niñas con infección urinaria, de 13 y 8 meses, que desarrollan abscesos renales. En ambas, después de un uroanálisis sugestivo de infección urinaria, se inicia manejo empírico con amikacina. El reporte del urocultivo muestra crecimiento de Escherichia coli (E. coli) >100 000 UFC/ml, sensible a dicho antibiótico, con ecografía renal inicial normal en el primer caso y en el segundo con nefromegalia derecha. A pesar del manejo antibiótico persistió la fiebre por más de tres días, por lo que se sospecha una complicación supurada. En el primer caso, la ecografía renal de control refleja imágenes sugestivas de absceso renal, pero en el segundo, a pesar de ecografías seriadas, solo se reportó la nefromegalia, que llevó realizar una tomografía abdominal con contraste para confirmar el diagnóstico. El antibiótico inicial, a pesar de la sensibilidad in vitro, no fue capaz de controlar la formación de abscesos renales. En el primer caso, el proceso infeccioso se controló utilizando amikacina y ceftriaxona, pero en el segundo fue necesario meropenem y amikacina. En ningún momento se alteró la función renal. Es de anotar lo infrecuente que es el absceso renal en niños en nuestra institución, ya que no se ha encontrado ningún caso en varios años. Conclusiones. El absceso renal en pediatría no es frecuente, se desarrolla principalmente tras una infección urinaria. Son necesarios una alta sospecha y un adecuado diagnóstico para orientar su manejo, ya sea solo médico o asociado a drenaje quirúrgico.

Summary Introduction: Renal abscesses are not common in pediatrics after urinary tract infections. Case reports: The two cases involve two 8 and a 13 month old girls with urinary tract infections, who also develop renal abscesses. In both cases, after a urinalysis shows signs of urinary tract infections, empirical management with amikacin is initiated. The uroculture report shows a growth of Escherichia coli (E. coli) >100,000 CFU/ml, sensitive to the given antibiotic, with a normal initial renal ultrasound in the first case and right nephromegaly in the second case. Despite the antibiotic treatment, the fever persisted for more than three days, which is why a suppurative complication is suspected. In the first case, the renal ultrasound from the control suggests the presence of a renal abscess, but in the second case, despite serial ultrasounds, only nephromegaly was reported; therefore, an abdominal tomography with contrast was performed in order to confirm the diagnosis. The initial antibiotic, despite in vitro sensitivity, was not able to control the formation of renal abscesses. In the first case, the infectious process was controlled using amikacin and ceftriaxone, but in the second case, meropenem and amikacin were necessary. At no point in time did the renal function change. It is important to note how infrequent renal abscesses in children are in our institution, given that there have not been any reported cases for several years. Conclusions: Renal abscesses in pediatrics are not frequent; they develop mainly after a urinary tract infection. A high level of suspicion along with an adequate diagnosis is needed in order to guide its management, be it only medical or associated with surgical drainage.

Resumo Introdução. Os abscessos renais após uma infeção urinária em pediatria não são frequentes. Relatório dos casos. Trata-se de duas meninas com infeção urinária, de 13 e 8 meses, que desenvolvem abscessos renais. Em ambas, após uma análise de urina sugestiva de infeção urinária, se inicia manejo empírico com amika-cina. O relatório da cultura de urina mostra crescimento de Escherichia coli (E. coli) >100 000 UFC/ml, sensível a este antibiótico, com ultrassonografia renal inicial normal no primeiro caso e no segundo com nefromegalia direita. Apesar do manejo antibiótico persistiu a febre por mais de três dias, motivo de suspeita de uma complicação supurada. No primeiro caso, a ecografia renal de controle reflete imagens sugestivas de abscesso renal, mas no segundo, apesar de ultrassonografias seriadas, só foi reportada a nefromegalia, que levou a realizar uma tomografia abdominal com contraste para confirmar o diagnóstico. O antibiótico inicial, apesar da sensibilidade in vitro, não foi capaz de controlar a formação de abscessos renais. No primeiro caso, o processo infecioso foi controlado utilizando amikacina e ceftriaxona, mas no segundo foi necessário meropenem e amikacina. Em nenhum momento foi alterada a função renal. Vale anotar que o abscesso renal em crianças em nossa instituição é pouco frequente, já que não há registro de caso algum em vários anos. Conclusões. O abscesso renal em pediatria não é frequente, se desenvolve principalmente após uma infeção urinaria. É necessário uma alta suspeita e um adequado diagnóstico para orientar seu tratamento, seja somente médico ou associado à drenagem cirúrgica.

Participation of Clinical Pharmacists in the Treatment of One Case of Renal Abscess with Iron Deficiency Anemia / 中国药师

Objective: To make out the optimal drug treatment regimen through the participation of clinical pharmacists in the treatment of one case of child with renal abscess complicated with iron deficiency anemia.Methods: Clinical pharmacists participated in the design of treatment program for the child, including the choices of drugs, dosage and route, and the treatment of adverse reactions, in order to make out the individualized medication.Results: By selecting the sensitive antibiotics, the renal abscess caused by Escherichia coli was cured successfully.Conclusion: Clinical pharmacists participating in clinical consultation can further optimize the treatment plan, and play an active role in the treatment of infected patients.

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Pyogenic renal abscess mimicking as Malignancy.

A 64 years male farmer presented with history of painless gross hematuria for 1 month and severe loss of weight and appetite for 2 months. There was a history of single episode of fever for 1 day without chills and rigors, about 1 month ago. There was no history of tuberculosis. On examination patient had severe pallor, no raised temperature and no tenderness at renal angle. His hemoglobin on admission was 5.7gm%. Enhanced CT scan showed right kidney having irregular low density lesion at the lower pole with perirenal fluid collection. Urine for culture sensitivity showed growth of Escherichia coli sensitive to norfloxacin and so patient was put on oral norfloxacin for 14 days. A CT guided fine needle aspiration biopsy was planned for the patient for a definite diagnosis. But a repeat ultasonography before the procedure, showed both kidneys to be normal. The lesion had vanished!

Endoftalmitis endógena secundaria a un absceso renal / Endogenous endophthalmitis secondary to a renal abcess

La endoftalmitis endógena puede ocurrir en aquellos casos de inflamación de los tejidos oculares internos secundaria a infección intraocular, resultado de la diseminación hematógena de los microorganismos desde un foco distal al ojo. Es el grupo menos frecuente de todas las endoftalmitis (5 por ciento), es preferentemente unilateral, y en la mayoría de los pacientes se aprecia al menos un foco extraocular infeccioso. Aunque puede darse en pacientes sanos inmunocompetentes, esta enfoftalmitis afecta fundamentalmente a pacientes con uno o más factores de riesgo, entre ellos, enfermedades crónicas, procedimientos quirúrgicos, neoplasias, usuarios de drogas administradas por vía parenteral, inmunodeficiencias, catéteres intravenosos. Se presenta un caso de una paciente diabética con una endoftalmitis endógena secundaria a un tumor renal, cuyo cuadro inicial apuntaba hacia un coma diabético y en la medida que evolucionó y a través del estudio oftalmológico se logró un completo diagnóstico y tratamiento de su problema de salud

The endogenous endophthalmitis may occur in cases of internal tissue inflammation secondary to intraocular infection, as a result of the hematogenous dissemination of microorganisms from a distal focus to the eye. It is the less frequent group of all types of endophthalmitis (5 percent), preferably unilateral, and most of the cases present with an extraocular infectious focus. Although it may appear in healthy immuno competent patients, this endophthalmitis mainly affects patients with one or more risk factors such as chronic illnesses, surgical procedures, neoplasias, parenterally administered drug users, immunodeficiencies and intravenous catheters. A case of a diabetic female patient with endogenous endophthalmitis secondary to a renal tumor was presented. Her initial clinical picture pointed to diabetic coma, but as the disease evolved and based on the ophthalmological study, it was possible to reach a complete diagnosis and to apply a treatment for her health problem

Intrarenal Abscess: When to Suspect.

Renal abscess is not so common therefore hardly suspected and often missed. Situation worsens when there is comorbid illness like malaria, which repeatedly tests positive further misleading the clinician leading to prolonged or recurrent fever or abdominal emergencies. When to suspect renal abscess is crucial, hence this report.

Effect of diabetes on mortality and length of hospital stay in patients with renal or perinephric abscess

OBJECTIVES: We compared the risk of in-hospital mortality and the length of hospital stay between diabetic and non-diabetic patients hospitalized for renal or perinephric abscess. METHOD: The data analyzed in this study were retrieved from Taiwan's National Health Insurance claims. The risk of in-hospital mortality and the length of hospital stay were compared between 1,715 diabetic patients, hospitalized because of renal or perinephric abscess in Taiwan between 1997 and 2007, and a random sample of 477 non-diabetes patients with renal or perinephric abscess. RESULTS: The in-hospital mortality rates from renal or perinephric abscess for the diabetic patients and the non-diabetic patients were not different, at 2.3% and 3.4%, respectively. However, diabetes was significantly associated with a longer length of hospital stay among patients with renal abscess, by 3.38 days (95% confidence interval [CI]: 1.59-5.17). CONCLUSIONS: Diabetes does not increase the risk of in-hospital mortality from renal or perinephric abscess. Nevertheless, appropriate management of patients with diabetes and concurrent renal or perinephric abscess is essential to reduce the length of hospital stay. .

Absceso renal en el embarazo / Renal abscess in the pregnancy

El absceso renal es una grave e infrecuente complicación de las infecciones del tracto urinario, siendo excepcional durante el embarazo. Su sintomatologia es inespecífica, por lo que el diagnóstico debe buscarse en forma activa. Se presenta un caso clínico de un absceso renal en una paciente cursando un embarazo gemelar, siendo tratada durante la gestación con buenos resultados.

Renal abscess is an infrequent but serious complication of the urinary tract infection, and exceptional in pregnancy. The symptomatology is unspecific, so the diagnosis must be pursued actively. We present a case report of a renal abscess in a twin pregnancy, treated successfully during gestation.

A Case of Infantile Urinary Tract Infection that Progressed to Renal Abscess Despite Early Antibi otic Treatment

Urinary tract infection (UTI) is most commonly diagnosed bacterial infection in febrile infants. Renal abscess is a very rare complication of UTI in children. Early diagnosis and treatment with appropriate antibiotics are important because renal scar correlates positively with the time of treatment. Renal ultrasonography and abdominal computerized tomography facilitates an earlier diagnosis and is also useful in establishing percutaneous drainage. Extended broad spectrum antibiotics therapy alone can be effective in most types of renal abscesses in infant, but some antibiotics-resistant cases need surgical drainage or nephrectomy. We report a case of a infant UTI, that progressed to renal abscess despite early antibiotic treatment and was treated with US guided percutaneous needle aspiration.

Klebsiella Pneumoniae Multi-organ Abscesses not Accompanied by Liver Abscesses: A Case Report

A Klebsiella pneumoniae infection has a tendency to spread to multiple organs. It is most commonly seen in patients with liver abscesses, but infection in more than three organs without liver abscesses is unusual. We report one case of a K. pneumoniae infection that presented acute pyelonephritis with left perirenal, anterior pararenal, left psoas, and prostate abscesses without liver abscesses in a diabetic patient. With effective antibiotics and ultrasound-guided percutaneous drainage, the patient recovered without significant sequelae.

Emphysematous Pyelonephritis

Urinary tract infection is very common and in most cases is self limiting even without treatment. However, in some cases, the infection may progress and leads to serious complication requiring admission and treatment. Emphysematous pyelonephritis is a rare but serious complication of urinary tract infection. The symptoms are similar to those seen in pyelonephritis and without radiological imaging; the diagnosis can be missed with serious consequence. In severe cases, nephrectomy may be indicated. We report a case of emphysematous pyelonephritis in a previously well obese 28 year old lady who was successfully managed with intravenous antibiotic. Her underlying risk factor was undiagnosed diabetes mellitus.

Drenaje percutáneo de absceso renal en niños: caso clínico / Percutaneous draining of a kidney abscess in children: a clinical case

Introduction: Renal abscesses in children are rare. Percutaneous draining is a useful tool, frequently used among adults. The objective of this presentation is to present a pediatric case of a percutaneous-drained renal abscess. Patients and Methods: A 9 year old girl with a history of recurring acute left pyelonephritis was admitted for a new episode, which evolved into a 4.6 cm renal abscess, detected on a sonogram. Antibiotic treatment was effective, resulting in clinical and image resolution. Ten days post treatment, the abscess recurred, this time it was treated with an aspiration punction and antibiotics, with a good clinical response. Follow up image showed resolution. Again, follow up showed a recurrence of the abscess. This time a percutaneous drain was utilized, with complete clinical and image resolution. Various therapeutic alternatives, and the use of drains in children are discussed.

Introducción: Los abscesos renales en niños son infrecuentes. El tratamiento con drenaje percutáneo es una herramienta útil, y frecuentemente utilizada en adultos. El objetivo es presentar la experiencia en drenaje per-cutáneo de un absceso renal en paciente pediátrico. Paciente y Método: Se reporta el caso de una paciente de 9 años, de sexo femenino, con antecedente de pielonefritis aguda izquierda a repetición. Presenta un cuadro de pielonefritis aguda complicada, evolucionando con un absceso renal de 4,6 cm, detectado por ecotomografía. Es tratada con esquema antibiótico biasociado, con mejoría clínica e imagenológica. Evoluciona con reproducción del absceso a los 10 días post tratamiento, manejándose en esta ocasión con punción aspirativa y antibióticos, obteniendo buena respuesta clínica y resolución imagenológica. Posterior al tratamiento presenta recidiva del absceso, tratándose en esta ocasión con drenaje percutáneo, con mejoría clínica y radiológica definitiva, y sin presentar reproducción del absceso en el seguimiento alejado. Se discuten las distintas alternativas terapéuticas y el uso del drenaje percutáneo en el manejo del absceso renal en los niños. Conclusión: El drenaje percutáneo del absceso renal se debe tener presente como una alternativa a la cirugía en el tratamiento de abscesos renales en casos seleccionados.

Clinical Features and Antimicrobial Resistance among Clinical Isolates of Women with Community-Acquired Acute Pyelonephritis in 2001-2006 / 감염과화학요법

BACKGROUND: Acute pyelonephritis in women is one of the most common infections within the community; some patients also suffer from related bacteremia and renal abscess. The predominant pathogen in acute pyelonephritis is Escherichia coli and the changes in antimicrobial resistance over time is a very important factor in the choice of effective and economic antibiotics. MATERIALS AND METHODS: We investigated clinical features and antibiotic sensitivities of 577 organisms isolated from the urine cultures of 577 patients, admitted to Catholic University St Vincent's Hospital for community-acquired acute pyelonephritis from January 2001 to December 2006. We analyzed the patterns of antimicrobial resistance of urinary isolates and the clinical courses of the patients. RESULTS: Patients demographics revealed a mean age of 51, (age:16 to 91), with bacteremic patients representing 30.8% of patients and renal abscess patients representing 5.9% of the group. Sixteen (4.2%) of 382 in the pyelonephritis group and five (3.1%) of 161 in the bacteremia group revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria. The mean time to defervescence was 44.6 h for the pyelonephritis group, 76.4 h for the bacteremia group and 91.2 h for the renal abscess group. Among the 577 isolates, 554 isolates were E. coli, 10 were K. pneumoniae, three were S. saprophyticus, three were Proteus mirabilis. two were K. oxytoca, and two were Enterobacter aerogenes. Among 554 E. coli, the rates of susceptibility to ampicillin was 38.3%; to sulfamethoxazole 62.1%; to gentamicin 81.3%; to ciprofloxacin 86.3%; to cefuroxime 97.3%; to amikacin 98.7%; to cefotaxime 99.5%. CONCLUSION: In hospitalized patients, initial intravenous treatment with an aminoglycoside or a second -generation cephalosporin, and then switch to oral first, second-cephalosporin, amoxicillin and sulfamethoxazole is recommended. In vitro resistance to fluoroquinolones appears to be increasing, and therefore close monitoring of antibiotic susceptibility patterns in isolates of urinary tract infections and the use of fluoroquinolone-sparing agents are required.

Clinical Features and Antimicrobial Resistance among Clinical Isolates of Women with Community-Acquired Acute Pyelonephritis in 2001-2006 / 감염과화학요법

BACKGROUND: Acute pyelonephritis in women is one of the most common infections within the community; some patients also suffer from related bacteremia and renal abscess. The predominant pathogen in acute pyelonephritis is Escherichia coli and the changes in antimicrobial resistance over time is a very important factor in the choice of effective and economic antibiotics. MATERIALS AND METHODS: We investigated clinical features and antibiotic sensitivities of 577 organisms isolated from the urine cultures of 577 patients, admitted to Catholic University St Vincent's Hospital for community-acquired acute pyelonephritis from January 2001 to December 2006. We analyzed the patterns of antimicrobial resistance of urinary isolates and the clinical courses of the patients. RESULTS: Patients demographics revealed a mean age of 51, (age:16 to 91), with bacteremic patients representing 30.8% of patients and renal abscess patients representing 5.9% of the group. Sixteen (4.2%) of 382 in the pyelonephritis group and five (3.1%) of 161 in the bacteremia group revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria. The mean time to defervescence was 44.6 h for the pyelonephritis group, 76.4 h for the bacteremia group and 91.2 h for the renal abscess group. Among the 577 isolates, 554 isolates were E. coli, 10 were K. pneumoniae, three were S. saprophyticus, three were Proteus mirabilis. two were K. oxytoca, and two were Enterobacter aerogenes. Among 554 E. coli, the rates of susceptibility to ampicillin was 38.3%; to sulfamethoxazole 62.1%; to gentamicin 81.3%; to ciprofloxacin 86.3%; to cefuroxime 97.3%; to amikacin 98.7%; to cefotaxime 99.5%. CONCLUSION: In hospitalized patients, initial intravenous treatment with an aminoglycoside or a second -generation cephalosporin, and then switch to oral first, second-cephalosporin, amoxicillin and sulfamethoxazole is recommended. In vitro resistance to fluoroquinolones appears to be increasing, and therefore close monitoring of antibiotic susceptibility patterns in isolates of urinary tract infections and the use of fluoroquinolone-sparing agents are required.

A Case of Neonatal Renal Abscess Treated with Antibiotics Only / 대한주산의학회잡지

A renal abscess is rare disease in neonates and the clinical diagnosis is difficult, because symptoms are often insidious and nonspecific such as fever and lethargy. A high degree of suspicion is important for the early detection of renal abscess. The diagnosis can be made with renal ultrasonography and CT scan. The treatment include aggressive antibiotic therapy, percutaneous aspiration of abscess, and surgical intervention. We experienced a case of renal abscess in a neonate which was treated successfully by antibiotics therapy without percutaneous aspiration or surgical intervention.

A Case of Multiple Large Renal Abscesses Completely Resolved by Conservative Antibiotics Administration

Renal abscess in childhood is a rare disease, and generally treatment of renal abscesses in childhood follows the guidelines in adults. The guidelines of treatment of renal abscesses in adults include the following:renal abscesses smaller than 3 cm in size can be managed by antibiotics administration, while renal abscesses above 3 cm in size must be considered for percutaneous abscess drainage or open drainage. We experienced a case of a 2 year-old girl with multiple renal abscesses greater than 4 cm in size which resolved by oral antibiotics administration after 2 weeks of intravenous administration. We report this case with literature review.

A Case of Renal abscess in Neonate

The renal abscess is a rare disease in neonate. The clinical findings consist of non- specific symptoms such as fever, lethargy, flank mass and laboratory abnormalities including leukocytosis, elevated CRP, ESR and pyuria. The diagnosis can be made with ultrasonography, CT scan and DMSA. The renal abscess involving corticomedullary region is known to be frequently associated with urologic abnormality and can progress into perirenal abscess which has been reported to have a poor prognosis. The treatments include antibiotic therapy, drainage of abscess and surgical intervention. We report a neonate with bilateral renal abscesses with underlying vesicoureteral reflux grade V which was successfully treated with antibiotic therapy and drainage of abscess.

A Clinical Study of Renal Abscesses in Children

PURPOSE: Renal abscess is very rare in children and its diagnosis is difficult because symptoms are often nonspecific. In previous studies, only 15% to 25% of patients were reported to be diagnosed at the time of admission. Early diagnosis and treatment are important because mortality rate correlates positively with the time of diagnosis. The purpose of this study is to clarify the clinical features of children with renal abscess and to investigate the possible indicators of this disease for early diagnosis and proper treatment. METHODS: Twelve children diagnosed with renal abscess from Jan. 1996 to Jul. 2004 were included. The age of patients ranged from 5 months to 15 years. We retrospectively analyzed the demographics of patients, their symptoms, predisposing factors, diagnostic methods and causative organisms and the treatment modalities. RESULTS: Fever was the most common manifestation. Five children(42%) had vesicoureteral reflux. Renal ultrasonography and computerized tomography were the most frequently used imaging tools to detect renal abscess. Gram negative bacteria were isolated in 7 patients and Staphylococcus aureus grew in 2 patients. All patients received intravenous antibiotics and 4 patients underwent aspiration or drainage of renal abscess. The average admission duration was 30 days. CONCLUSION: Renal abscess should be included in the differential diagnosis of prolonged fever in children, especially when flank pain is combined. For early diagnosis and a better prognosis, patients should be promptly investigated with ultrasonography or computerized tomography.