Sepsis due to ureteral stones in a patient with uremia: a case report / 中华泌尿外科杂志

Urosepsis caused by upper urinary tract stone obstruction is a common critically disease in urology.However, it rarely occurs in the patient who underwent a dialysis with uremia.We report a patient who underwent an implantation of ureteral stent to control the infection, and we saved the patient with perinephric hematoma following the surgery. We removed the stones in the left ureteral through a flexible ureteroscope two month later.The hematoma was completely absorbed 6 months after the implantation of ureteral stent.

Solitary tubercular renal cyst in a postpartum lady masquerading as an infected giant renal cyst with urosepsis

Renal tuberculosis presenting as renal cyst is rare. Diagnosing renal tuberculosis in pregnancy is usually delayed due to its atypical presentation. We present a 28-year-old postpartum lady who delivered a healthy baby one month back, with history of intermittent fever and chills. She had high spiking fever (102° F), tachycardia (130/min) and computed tomography showed a 16 × 10 cm right renal cyst. Percutaneous drainage was done, 2 litres of thick pus drained and culture was sterile. After three weeks, deroofing and marsupialization of cyst was done. Biopsy revealed granulomatous inflammation composed of epitheliod histiocytes with central incipient necrosis suggestive of tuberculosis. She was treated with anti-tubercular drugs. As the infant was healthy and had no evidence of tuberculosis, no treatment was initiated. The mother is on follow up for 2 years. This case highlights the rare presentation of renal tuberculosis in puerperium.

Value of urine IL-8, NGAL and KIM-1 for the early diagnosis of acute kidney injury in patients with ureteroscopic lithotripsy related urosepsis / 中华创伤杂志(英文版)

PURPOSE@#To investigate the clinical value of urine interleukin-18 (IL-8), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for the early diagnosis of acute kidney injury (AKI) in patients with ureteroscopic lithotripsy (URL) related urosepsis.@*METHODS@#A retrospective study was carried out in 157 patients with urosepsis after URL. The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8, NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0, 4, 12, 24 and 48 h after the surgery. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.@*RESULTS@#The level of urine IL-8, NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4, 12, 24 and 48 h (p < 0.01). The ROC analysis showed the combined detection of urine IL-8, NGAL and KIM-1 at 12 h had a larger area under curve (AUC) than a single marker (0.997, 95% CI: 0.991-0.998), and the sensitivity and specificity were 98.2% and 96.7%, respectively. Pearson correlation analysis showed that the levels of urine NGAL at 4, 12, 24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18 (p < 0.01).@*CONCLUSION@#AKI could be quickly recognized by the elevated level of urine IL-8, NGAL and KIM-1 in patients with URL-related urosepsis. Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance, which may be an important reference for the early diagnosis of AKI.

The value of IL-6 in the diagnosis, treatment and prognostic improvement of urosepsis at 2 hours after percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective:To explore the value of IL-6 in the diagnosis, treatment and improving prognosis of urosepsis at 2 hours after percutaneous nephrolithotomy.Methods:Twenty-five patients with urosepsis undergoing percutaneous nephrolithotomy in the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to June 2021 were analyzed retrospectively, including 6 males and 19 females, aged (55.4±11.6) years, and there were 10 cases with hypertension, 11 cases with diabetes and 14 cases with hydronephrosis. There were 10 cases with Stone volume>353mm 2, 22 cases with pyuria, 12 cases with positive nitrite and 18 cases with positive urine culture before operation. Among them, 13 patients were classified into experimental group with the test of IL-6 at 2 hours after operation and 12 patients were classified into control group without the test of IL-6 at 2 hours after operation. IL-6>1 000 pg/ml at 2 hours after operation as the standard for diagnosis of urosepsis was used to guide the anti-infective treatment after percutaneous nephrolithotomy. The operation time, severity of urinary sepsis (severe sepsis and septic shock), diagnostic time of urosepsis after operation, and hospital stay after operation were compared between the two groups. Results:There were 13 patients including 9 females with average age of (52.4±12.2) years in the experimental group, and there were 6 cases with hypertension, 5 cases with diabetes and 9 cases with hydronephrosis, 5 cases with stone volume>353mm 2, 12 cases with pyuria, 7 cases with positive nitrite and 10 cases with positive urine culture before operation. There were 12 patients including 10 females with average age of (58.7±10.5) years in the control group, and there were 4 cases with hypertension, 6 cases with diabetes, 5 cases with hydronephrosis, 3 cases with stone volume>353mm 2, 10 cases with pyuria, 5 cases with positive nitrite, and 8 cases with positive urine culture before operation. There was no significant difference between the two groups in terms of gender( P=0.645), average age ( P=0.182), hypertension( P=0.688), diabetes( P =0.695), hydronephrosis( P=0.238), stone volume>353 mm 2( P=0.673), pyuria( P=0.593), positive nitrite( P=0.695), and positive urine culture( P=0.673). There was not significant difference in the general clinical data of gender, age, hypertension, diabetes, stone burden, hydronephrosis, pyuria, positive nitrite and positive urine culture between the two groups ( P>0.05). The mean value of IL-6 in the test group was (6 824.4±1 473.3) pg/ml. The operative time of the experimental group with (100.8±27.8) minutes was longer than that of the control group with (88.3±39.3) minutes, but the difference between the two groups was not statistically significant ( P=0.645). The diagnostic time of urosepsis after operation in the test group with (3.6±2.0) hours was shorter than that in the control group with (6.0±3.0) hours, and the difference between the two groups was statistically significant ( P=0.023). The postoperative hospital stay in the test group with (6.1±1.6) days was shorter than that in the control group with (8.2±2.3) days, and the difference between the two groups was statistically significant ( P=0.014). Three patients with severe sepsis and septic shock in the test group, which were less than that of eight patients with severe sepsis and septic shock in the control group, and the difference between the two groups was statistically significant ( P=0.047). Conclusion:The detection of IL-6 at 2 hours after percutaneous nephrolithotomy can early diagnose urosepsis, reduce the severity of postoperative urosepsis, shorten the postoperative hospital stay, and improve the prognosis.

The relationship between short-term serum albumin level and postoperative urogenic sepsis after mPCNL / 中华泌尿外科杂志

Objective:To investigate the predictive value of serum albumin (Alb) levels in the early postoperative period (within 1 hour) for urosepsis after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods:The clinical data of 160 patients treated by single channel holmium laser mPCNL in urolithiasis treatment center of the second hospital of Tianjin Medical University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into the sepsis group and the non-sepsis group according to whether the patients developed urosepsis after the operation. There were 110 cases of male, and 50 cases of female, with average age of(51.8±11.9), including 68 cases with hypertension, 26 cases with diabetes, 12 patients with history of preoperative fever, 16 cases with history of endoscopic lithotomy surgery, 6 patients with preoperative catheter, 24 patients with positive preoperative urine culture, 12 patients with positive preoperative nitrite volume, 32 cases with preoperative routine urine leucocyte(+ + + ). The operative time and infusion volume were recorded during the operation. Blood samples were collected from all patients within 1 hour after surgery to detect blood routine and serum albumin (Alb), and the change of haemorrhagic white blood cells and serum albumin were calculated. Univariate and multivariate analyses were used to statistically analyze the relevant clinical parameters to identify the independent risk factors for urosepsis after mPCNL surgery. The ROC curve was established and the area under the comparison curve was calculated to analyze the predictive value of independent risk factors for postoperative urosepsis.Results:There were 13 patients (8.1%) in the sepsis group, including 7 males and 6 females, with an average age of (53.1±8.2) years. There were 147 patients (91.9%) in the non-sepsis group, including 103 males and 44 females, with an average age of (51.7±12.1)years. Single factor analysis showed the infectious stones (38.5% and 8.8%), surgery duration [(94.6±26.2)min and(63.6±24.5)min], a positive urine culture (46.2% and 12.2%), positive urinary nitrite (30.8% and 5.4%), strong positive urinary leukocyte (61.5% and 11.3%), postoperative albumin levels [(34.2±2.7)g/L and(40.7±6.2)g/L]and changes of serum albumin levels within one hour after surgery [(18.3±4.6)% and(3.8±14.3)%] between the sepsis group and the non-sepsis group had significant differences ( P<0.05). Multiariable logistic regression analysis showed the strong positive urine leucocyte ( OR=57.704, 95% CI 2.407-1383.427, P=0.012), postoperative blood leucocyte level within one hour after surgery ( OR=2.406, 95% CI 1.154-3.627, P=0.014) and the change of serum albumin levels after surgery ( OR=1.373, 95% CI 1.083-1.740, P=0.009) were independent risk factors for sepsis. ROC curve analysis indicated that the AUC of the change amplitude of serum albumin level was 0.926, which was significantly higher than the AUC of the qualitative results of blood leukocyte and the AUC of urinary leukocyte( P<0.01). Conclusions:The positive urinary leucocyte, the change of serum albumin levels after surgery within one hour and the leucocyte level are independent risk factors for postoperative urosepsis after mPCNL. The change of serum albumin level in the early postoperative period has a strong predictive value for the early diagnosis of postoperative sepsis.

Characters and emergency treatment of upper urinary tract stone obstruction complicated with urosepsis / 中华泌尿外科杂志

Objective:To investigate the characters and emergency treatment strategy of upper urinary tract stone obstruction complicated with urosepsis.Methods:Clinical data of 28 cases of urosepsis, caused by upper urinary tract stone obstruction and arranged for emergency admission in our hospital during January 2018 to December 2019, were retrospectively analyzed. There were 6 males and 22 females. The median age was 54(32-93)years old. All patients had fever with the temperature ranged from 38.5 to 41.0 ℃. The median course of disease was 3 (ranging 1-14) days. The systolic blood pressure ranged from 76 to 138 mmHg at admission. Hypotension group was defined as the systolic blood pressure<90 mmHg after admission. Normotensive group was defined as the systolic blood pressure≥90 mmHg. There were 12 cases in hypotension group, including 3 males and 9 females. The median age was 57 (ranging 32-93) years old. The stones located at left side in 7 cases and right side in 5 cases. The stones located at the upper ureter in 5 cases, middle ureter in 2 cases, lower ureter in 4 cases and renal calculi in one case. The median length of the stone was 10 (ranging 6-20) mm. Six cases suffered with diabetes mellitus. One case suffered with neuron system disease. 3 cases have history of recent extracorporeal shock wave lithotripsy(ESWL). There were 16 cases in normotensive group, including 3 males and 13 females with the median age of 53 (ranging 33-76) years old. The stones located at left side in 5 cases, right side in 9 cases and bilateral in 2 cases. The stones located at the upper ureter in 10 cases, middle ureter in 4 cases, lower ureter in 2 cases. The length of the stone was 10 (ranging 8-14) mm. There were 3 cases with neurological diseases and 3 cases with recent ESWL history. There was significant difference between hypotension group and normotensive group in ration of diabetes mellitus ( P=0.024). Blood routine examination, C-reactive protein (CRP), procalcitonin(PCT), blood and urine bacterial culture were performed in both groups. The patients were treated with empiric antibiotics after the evaluation based on the sequential organ failure assessment (SOFA). Patients with hypotension were given blood volume expansion, and vasoactive drugs were added when the blood pressure was still low. After the blood pressure was stable, the collection system decompression was performed. The difference of infection indicators and therapeutic methods between the two groups was compared. Results:There was no significant difference in median WBC [16.34 (2.55-41.65) × 10 9/L vs. 13.97(6.23-26.65) × 10 9/L, P=0.577], median CRP [143.0(74.2-200.0) ng/ml vs.110.0 (22.7-200.0) ng/ml, P=0.771] between hypotension group and normotensive group. The difference of PCT [95.5 (26.5-200.0) ng / ml vs. 57.6 (1.0-200.0) ng / ml, P=0.040] and PLT [65.5(14.0-170.0)×10 9/L vs. 73.0(17.0-412.0)×10 9/L, P=0.030] between hypotension group and normotensive group was statistically significant. The median SOFA scores of hypotension group and normotensive group were significantly different [8.5(3.0-13.0) vs. 5.0(2.0-8.0), P=0.001]. Ureteral stent placement was performed in 23 cases, and nephrostomy was performed in 5 cases. There was no significant difference in surgical drainage between the two groups ( P=0.887). Eight patients in hypotension group were admitted to ICU. There was no significant difference in the duration of antibiotic use between hypotension group and normotensive group [8 (3-12) d vs. 5 (3-7) d, P=0.453]. Sepsis was cured in both groups after decompression, fluid resuscitation and antibiotic treatment. Conclusions:In severe cases of upper urinary tract stone obstruction complicated with urogenic sepsis, septic shock may occur. The condition is urgent, severe and dangerous. Patients with hypotension had higher PCT and SOFA scores, and lower PLT. It is very important to carry out the collection system decompression drainage in time, liquid resuscitation, early effective antibiotic use.

Bacteriology and antibiotic sensitivity pattern of isolates in patients who underwent Percutaneous Nephrolithotripsy (PCNL) at the Philippine General Hospital: A retrospective cohort study

@#<p style="text-align: justify;"><strong>Background.</strong> Despite being a clean-contaminated procedure, performed only in patients with sterile urine preoperatively, percutaneous nephrolithotripsy (PCNL) is associated with significant infectious perioperative complications. A local antibiogram is of paramount importance in optimizing antibiotic prophylaxis in PCNL because of the substantial variation in bacterial distribution and antibiotic sensitivity worldwide.</p><p style="text-align: justify;"><strong>Objectives.</strong> The incidence of post-PCNL infectious complications, microorganism distribution, and antibiotic sensitivities from patients admitted for PCNL was determined. The risk factors associated with positive cultures and the development of fever and bacteremia were also analyzed.</p><p style="text-align: justify;"><strong>Methods.</strong> A retrospective study of 102 patients who underwent PCNL under a surveillance protocol was done. The susceptibility of isolates from different specimens was evaluated against the most common antibiotics in the hospital. Chi-square and Student's t-test were used to determine differences in the frequencies and means for other risk factors for those who developed fever and urosepsis and those who did not.</p><p style="text-align: justify;"><strong>Results.</strong> The incidence of fever and urosepsis was 25% and 4%, respectively. The most common organism on urine specimens was Escherichia coli which showed high sensitivity to aminoglycosides. The most common isolate on stones was Pseudomonas aeruginosa, which showed higher sensitivities to the fluoroquinolones. The isolates showed nearly consistent resistance to ceftriaxone. No significant association was found between the clinical variables studied and the occurrence of infectious complications.</p><p style="text-align: justify;"><strong>Conclusion.</strong> There are comparable rates of infectious complications to published literature. A change in antibiotic prophylaxis was warranted, given the high resistance to ceftriaxone and the predominance of Pseudomonas aeruginosa on stone isolates. Further surveillance is required to identify significant risk factors for the development of post-PCNL infectious complications.</p>

Percutaneous nephrostomy, feasibility of mid and anterior axillary line approach and its complications: an experience

Background: Nephrostomy performed as an emergency procedure to drain the obstructed calyceal system is a lifesaving procedure. Posterolateral approach is usually done to access the avascular plane of Brodel to avoid hemorrhage. This study evaluates the feasibility and complications in percutaneous nephrostomies placed at mid and anterior axillary line entry sites as it was found to be easier approach.Methods: A prospective study with 126 percutaneous nephrostomies performed with Ultrasound guidance, using single puncture technique and 8.5F pigtail catheter.  The complications rates were analyzed according to WHO guidelines. Results: The technical success rate was 98.4%. Three hemorrhagic complications (2.38%) were recorded without any major interventions. Increased incidence (11.9%) of transient hematuria was observed with five cases (3.9%) of infection at entry site. One case (0.79%) of peritoneal breech recorded with no significant intraperitoneal collection. Conclusions: Placement of Percutaneous Nephrostomy tube at mid or the anterior axillary line appears to be a feasible and easy approach, as its complications rates are within acceptable limits with an advantage of increased patient comfort.

The value of heparin-binding protein in predicting urosepsis after endoscopic lithotripsy for upper urinary tract stones / 中华泌尿外科杂志

Objective To investigate the value of heparin-binding protein(HBP) in predicting urosepsis after endoscopic lithotripsy for upper urinary tract stones.Methods From January to November 2018,635 cases of upper urinary tract stones treated by endoscopic lithotripsy in our hospital was analyzed.According to the 2014 edition Chinese Guidelines of the diagnosis and treatment of urosepsis,all patients were divided into two groups,the definite urosepsis group (n =53,8.3％) and the no urosepsis group (n =582,91.7％).The serum of HBP level was detected by fluorescence immunoassay technology.The serum of procalcitonin (PCT) level was detected by cyclic enhanced immunofluorescent assay.C-reactive protein (CRP) level was detected by automatic chemiluminescence immunoassay analyzer.White blood cells (WBC) count was performed by hematology analyzer.Receiver operating characteristic(ROC) curves were constructed by SPSS 22 and MedCale,and areas under curves (AUC) were calculated and compared to illustrate the diagnostic power of HBP,PCT,CRP and WBC.The correlation between HBP and WBC was also significant (r =0.68,P ＜ 0.05).Results The level of HBP,PCT,CRP and WBC were significantly higher in the definite urosepsis group compared to the no urosepsis group.AUC of HBP,PCT,CRP and WBC were 0.930,0.878,0.727 and 0.617.When the cutoff of HBP,PCT,CRP and WBC were set as 51.5 ng/ml,0.41 ng/ml,64.2 mg/L and 11.7 × 109/L,the sensitivities were 89.2％,83.3％,83.5％ and 44.7％,and the specificity were 95.9％,75.6％,64.3％ and 77.1％,respectively.Conclusions The value of heparin-binding protein was superior to that of PCT,CRP and WBC in predicting urosepsis after endoscopic lithotripsy for upper urinary tract stones.Heparin-binding protein could be acted as a diagnostic marker for urosepsis.

Application of diffusion-weighted magnetic resonance imaging in the differential diagnosis of hydronephrosis and pyonephrosis / 中华泌尿外科杂志

Objective To study the effect of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of hydronephrosis and pyonephrosis.Methods From March 2015 to October 2017,50 patients with renal stone and highly suspected infectious hydronephrosis underwent renal DW-MRI,and clinical materials were collected and analyzed retrospectively.Seventeen male and 33 female patients were enrolled with a mean age of (49.40 ±-10.51) years.The median maximum diameter of renal stone was 30.30 (17.38,56.01) mm and hydronephrosis was 46.39 (34.33,56.55) mm.No pyonephrosis was diagnosed by preoperative ultrasound or CT,while 29 cases of hydronephrosis and 21 cases of pyonephrosis were reported by preoperative DW-MRI.Final diagnoses of hydronephrosis and pyonephrosis were made according to whether the pelvic urine drainage was purulent or not during the surgery.DW-MRI reports and characteristics of DW images were analyzed retrospectively.Apparent diffusion coefficient (ADC) was calculated and ADC map constructed,which was compared between the two groups.Receiver operating characteristic curve (ROC) was drawn to analyze the area under curve (AUC) and the optimal cutoff of ADC value,with sensitivity and specificity.Results Thirty-three patients of hydronephrosis and 17 pyonephrosis were confirmed intraoperatively.The overall accuracy of diagnosis using DW-MRI was 84.00％ (42/50),with sensitivity of 88.24％ (15/17) and specificity of 81.82％ (27/33).Among 30 patients who underwent CT scan in our hospital,mean CT value of 18 hydronephrosis was (7.03 ± 3.26)HU and that of 12 pyonephrosis was (8.67 ± 3.52) HU,with no statistical significance (P ＞ 0.05).On DW image,when b ≥ 500 s/mm2,hydronephrosis signal intensity was lowered apparently,whereas pyonephrosis signal intensity was intensified.On ADC map,hydronephrosis appeared as hyperintensity,whereas pyonephrosis appeared as hypointensity.The mean ADC value of pyonephrosis group was lower than hydronephrosis group [(1.53 ±0.58) × 10-3 mm2/s vs.(2.86 ±0.56) × 10-3 mm2/s,p ＜0.01].ROC analysis revealed that AUC =0.92 (95％ CI 0.80-0.98),and the cut-off value of ADC for pyonephrosis diagnosis was 1.39 × 10-3 mm2/s,of which the sensitivity and specificity was 94.12％ and 84.85％ respectively.Conclusions Signal of pyonephrosis was enhanced on DW image,while decreased on ADC image.The ADC value of pyonephrosis was much lower than that of hydronephrosis,with which the differential diagnosis between pyonephrosis and hydronephrosis could be made efficiently.

Caracterización de gestantes con urosepsis y resistencia antimicrobiana de Escherichia coli, Hospital General Docente Dr. Agostinho Neto, Guantánamo / Caracterização de gestantes portadoras de urossepse e resistência antimicrobiana de Escherichia coli, Hospital Dr. Agostinho Neto, Guantánamo / Characterization of pregnant women with urosepsis and antimicrobial resistance of Escherichia coli, Hospital Dr. Agostinho Neto, Guantánamo

Introducción: la resistencia combinada a múltiples antibióticos en algunas de las principales bacterias patógenas en humanos está aumentando en los últimos años y está generando una importante amenaza para la salud pública. Objetivo: caracterizar a las gestantes con urosepsis que presentaron resistencia antimicrobiana de Escherichia coli aislada en urocultivos y atendidas en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo durante el periodo enero-junio de 2017. Método: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital General Docente Dr. Agostinho Neto de Guantánamo, en el periodo enero a junio 2017. El universo de estudio quedó constituido por 58 gestantes. Las variables estudiadas fueron: edad, paridad, factores de riesgo y resistencia. Se utilizó como medida de resumen la frecuencia absoluta y la frecuencia relativa (por ciento). Resultados: el mayor número de gestantes con urosepsis causada por Escherichia coli se encontraban en el grupo de edades entre los 19 y 29 para un 48,3 por ciento. La urosepsis en etapas anteriores al embarazo se identificó en el 48,3 por ciento de las multíparas, solo 11 de las primíparas (19,0 por ciento). La anemia se diagnosticó en 28 gestantes (48,3 por ciento), la diabetes mellitus tipo II en 11 pacientes para un 19,0 por ciento. En 33 gestantes (57 por ciento), se presentó resistencia al ácido nalidíxico, en 28 al sulfaprim (48,2 por ciento) y en el 40 por ciento a la amoxicilina+ácido clavulánico un total de 23 pacientes. Conclusiones: la urosepsis por Escherichia coli predominó en gestantes comprendidas entre los 19 y 29 años, multíparas, con esta entidad en etapas anteriores al embarazo, anemia, multigestas y con diabetes mellitus. Se presentó resistencia al ácido nalidíxico, sulfaprim, amoxicilina + ácido clavulánico y cefalexina(AU)

Introduction: the combined resistance to multiple antibiotics in some of the main pathogenic bacteria in humans is increasing in recent years and is generating a major threat to public health. Objective: to characterize pregnant women with urosepsis who presented antimicrobial resistance of Escherichia coli isolated in urocultures and treated in the General Teaching Hospital Dr. Agostinho Neto of Guantanamo during the period from January to June 2017. Method: a descriptive study was carried out, transversal and retrospective in the General Teaching Hospital "Dr. Agostinho Neto" of Guantánamo, in the period January to June 2017. The universe of study was constituted by 58 pregnant women. The variables studied were: age, parity, risk factors and resistance. The absolute frequency and the relative frequency (percent) were used as a summary measure. Results: the greater number of pregnant women with urosepsis caused by Escherichia coli were in the age group between 19 and 29 for 48.3 percent. Urosepsis in stages prior to pregnancy was identified in 48.3 percent of the multiparous women, only 11 of the primiparous women (19.0 percent). Anemia was diagnosed in 28 pregnant women (48.3 percent), diabetes mellitus type II in 11 patients for 19.0 percent. In 33 pregnant women (57 percent), there was resistance to nalidixic acid, in 28 to sulfaprim (48.2 percent) and in 40 percent to amoxicillin + clavulanic acid a total of 23 patients. Conclusions: Urosepsis due to Escherichia coli predominated in pregnant women between 19 and 29 years of age, multiparous, with this condition in stages before pregnancy, anemia, multigesta and with diabetes mellitus. There was resistance to nalidixic acid, sulfaprim, amoxicillin + clavulanic acid and cephalexin(AU)

Introdução: a resistência combinada a múltiplos antibióticos em algumas das principais bactérias patogénicas em seres humanos está a aumentar nos últimos anos e está gerando uma ameaça significativa para a saúde pública. Objectivo: Para caracterizar as mulheres grávidas com urosepsis apresentando resistência antimicrobiana de E. coli isoladas a partir de culturas de urina e tratados no geral Ensino Dr. Agostinho Neto Hospital Guantánamo durante o período de Janeiro a Junho de 2017. Métodos: Um estudo descritivo, transversal e retrospectivo, no geral Ensino Dr. Agostinho Neto Hospital Guantánamo, no período de janeiro a junho de 2017. o grupo de estudo foi composto por 58 mulheres grávidas. As variáveis estudadas foram: idade, paridade, fatores de risco e resistência. A frequência absoluta e a frequência relativa (por cento) foram usadas como uma medida resumida. Resultados: o maior número de mulheres grávidas com urosepsis causada por E. coli foram no grupo de idade entre 19 e 29-48,3 por cento. Urosepsis em fases anteriores de gravidez foi identificada em 48,3 por cento dos multíparas, apenas 11 primíparas (19,0 por cento). Anemia foi diagnosticada em 28 mulheres grávidas (48,3 por cento), diabetes mellitus do tipo II em 11 pacientes de 19,0 por cento. Em 33 mulheres grávidas (57 por cento), ácido nalidíxico resistência é apresentado na sulfaprim 28 (48,2 por cento) e 40 por cento de Amoxicilina um total de 23 pacientes. Conclusões: urosepsis por E. coli predominou em mulheres grávidas entre 19 e 29 anos de idade, multíparas, com esta entidade em estágios iniciais da gravidez, anemia, diabetes mellitus e multigravidas. Houve resistência ao ácido nalidíxico, sulfaprim, amoxicilina + ácido clavulânico e cefalexina(AU)

Hydrogen sulfide attenuates urosepsis-induced acute kidney injury by blocking TLR4/MyD88/PI3K signaling pathway / 中国病理生理杂志

AIM:To explore the effect of hydrogen sulfide (H2S) on urosepsis-induced acute kidney injury.METHODS:New Zealand white rabbits were randomly divided into control group, sham group, model (sepsis) group, Na HS treatment (Na HS) group, and Na HS combined with TAK-242 (a TLR4 inhibitor) treatment (Na HS+TAK-242) group.After treatment for 72 h, HE staining was used to measure the histopathological changes of rabbit kidney.The levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were detected by automatic biochemical analyzer.The serum levels of neutrophil gelatinase-associated lipocalin (NGAL) , kidney injury molecule 1 (KIM-1) , procalcitonin (PCT) , interleukin-1β (IL-1β) , interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by ELISA.The TLR4/MyD88/PI3K signaling pathway-related proteins in the kidney were determined by Western blot.RESULTS:Compared with control group, obvious damage was observed in the kidneys of septic rabbits, but the kidneys were markedly improved by treatment with Na HS.The levels of BUN, SCr, NGAL, KIM-1, PCT, IL-1β, IL-6 and TNF-αin the septic rabbits were higher than those in control group, and decreased significantly in Na HS group and Na HS+TAK-242 group.The protein levels of TLR4, MyD88, p-PI3K and p-Akt in septic rabbit kidneys were higher than those in control group.However, Na HS or Na HS+TAK-242 inhibited the activation of TLR4/MyD88/PI3K signaling pathway in the kidneys of septic rabbits.CONCLUSION:H2S play a protective effect on the rabbits with urosepsis-induced acute kidney injury by blocking TLR4/MyD88/PI3K signaling pathway to inhibit inflammatory response.

Differential protein expression in patients with urosepsis / 中华创伤杂志(英文版)

PURPOSE@#Urosepsis in adults comprises approximately 25% of all sepsis cases, and is due to complicated urinary tract infections in most cases. However, its mechanism is not fully clarified. Urosepsis is a very complicated disease with no effective strategy for early diagnosis and treatment. This study aimed to identify possible target-related proteins involved in urosepsis using proteomics and establish possible networks using bioinformatics.@*METHODS@#Fifty patients admitted to the Urology Unit of Lanzhou General PLA (Lanzhou, China), from October 2012 to October 2015, were enrolled in this study. The patients were further divided into shock and matched-pair non-shock groups. 2-DE technique, mass spectrometry and database search were used to detect differentially expressed proteins in serum from the two groups.@*RESULTS@#Six proteins were found at higher levels in the shock group compared with non-shock individuals, including serum amyloid A-1 protein (SAA1), apolipoprotein L1 (APOL1), ceruloplasmin (CP), haptoglobin (HP), antithrombin-III (SERPINC1) and prothrombin (F2), while three proteins showed lower levels, including serotransferrin (TF), transthyretin (TTR) and alpha-2-macroglobulin (A2M).@*CONCLUSION@#Nine proteins were differentially expressed between uroseptic patients (non-shock groups) and severe uroseptic patients (shock groups), compared with non-shock groups, serum SAA1, APOL1,CP, HP, SERPINC1and F2 at higher levels, while TF, TTR and A2M at lower levels in shock groups.these proteins were mainly involved in platelet activation, signaling and aggregation, acute phase protein pathway, lipid homeostasis, and iron ion transport, deserve further research as potential candidates for early diagnosis and treatment. (The conclusion seems too simple and vague, please re-write it. You may focus at what proteins have been expressed and introduce more detail about its significance.).

The Clinical Significance of Eosinophil in Urosepsis / 实用医学杂志

Objective To discuss The Clinical Significance of Eosinophil (EOS) in urosepsis. Methods A total of 99 patients of urosepsis in Department of Urology,Guangdong Provincial TCM Hospital from Mar. 2013 to Jul. 2016 were selected as research objects by retrospective analysis. The patients were classified into groupEOS= 0 andgroup EOS > 0,group PCT(procalcitonin)≥ 2 ng/mL andgroup PCT 0 group,the percentage of EOS in PCT≥2 ng/mL groupwere lower than PCT<2 ng/mL group,difference were significant(P<0.05). And The Independent-Sample Testalso showed that the percentage of EOS of the Urosepsis group was definitely lower than the UTI group without Sepsis. Difference was statistically significant. Concusions The percentage of EOS could be applied to assess the severity of urosepsis, monitor the disease progression and evaluate the infection control. The cost was lower than PCT in therapeuticprocess ofurosepsis.

Effect of initial intervention based on white blood cell count measured within 2 hours postoperatively to treat uroseptic shock induced by upper urinary tract endoscopic lithotripsy (UUTEL) : animal experiments and clinical study / 中华泌尿外科杂志

Objective To investigate whether initial intervention based on WBC measured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL.Methods From May,2015 to July 2015,24 female New Zealand rabbits,weighing 2.0-2.5 kg,born 2-3 months,used as uroseptic shock model.Their ureters were ligated and followed by injection of Escherichia coli solution into the renal pelvis.Then,those animals were randomly assigned into control group(the first group)and experimental groups (the second group,the third group).Each group had 8 rabbits initially.The first group did not receive sensitive antibiotic or fluid resuscitation.The second group received imipenem and cilastatin sodium 15mg/kg and normal saline 5 ml/kg 2 hours postoperatively.The third group received sensitive antibiotic and fluid resuscitation the same dosage as the second group 6 hours postoperatively.Mean arterial pressure(MAP) was recorded for 10 hours and survival rate of all groups for 72h postoperatively was recorded..The clinical data of 46 patients whose WBC count less than 2.85 × 109/L within two hours after UUTEL were analyzed retrospectively.These patients were divided into two groups based on the time of intervention.Group A including 19 patients received routine antibiotic,fluid therapy,low-dose corticosteroids when there was symptom of shock.Group B including 27 patients immediately received resuscitation bundle protocol when there was a drastic decrease in WBC.The incidence of septic shock,the rate of intubation,length of stay in ICU,length of stay in hospital postoperatively,hospitalization cost and survival rate of these two groups were compared.Results All 8 rabbits of the first group died within 72 h,postoperatively and the median time of survival was 11 h.None of the second group rabbits developed shock and all rabbits survived 72 h after operation.6/8 rabbits of the third group survived 72 h after operation.15 patients in Group A and 3 patients in Group B experienced acute uroseptic shock (P ＜ 0.05).11 patients in Group A and one patients in Group B underwent tracheal intubation (P ＜ 0.05).18 patients in Group A and 6 patients in Group B were transferred to ICU(P ＜ 0.05),and their length of stay in ICU was (10.8 ± 5.4) d and (7.5 ± 2.8) d,respectively(P ＞ 0.05).The length of stay in hospital and hospitalization cost of Group A and B were (19 ± 9.8)d vs.(7 ±4.7)d(P ＜0.05),(94 583 ±51 623) RMB vs.(35 389 ± 16 342) RMB respectively (P ＜ 0.05).One patient in Group A died due to acute uroseptic shock and none of Group B died.Conclusions Our animal model and clinical cohort study showed that initial intervention based on WBC mneasured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL and improve the prognosis.

Xanthogranulomatous pyelonephritis with reno-colic fistula: A rare complication of urinary tract infection

Urinary tract infection (UTI) is one of the most common presentations in general practice and,in most instances, occurs in a single episode and is easily treated with a course of anti-microbialtherapy. In the case of recurrent urinary tract infections, it is important to consider evaluation forany underlying causes. We report the case of a 32 year old female who had recurrent UTIs; this wasa case of recurrent UTI secondary to xanthogranulomatous pyelonephritis from renal stones withresultant reno-colic fistula formation.

MALDI-TOF-MS Fingerprinting Provides Evidence of Urosepsis caused by Aerococcus urinae

Urosepsis due to Aerococcus urinae is rare in clinical settings with only a few of reported cases worldwide by 16S rRNA sequencing. Here we report a case of sepsis caused by A. urinae in a 86 year-old male with complicated urinary tract infection which was confirmed through peptide mass fingerprinting of matrix-assisted laser desorption ionization time of flight mass spectrometry.

Combined detection of procalcitonin and endotoxin in early diagnosis of urosepsis after percutaneous neph-rolithotomy / 医学研究生学报

[Abstract ] Objective At present, few studies are reported on procalciton (PCT) and endotoxin (ET) in the diagnosis of urosepsis after percutaneous nephrolithotomy ( PCNL) .The purpose of this study was to investigate the clinical value of the detection of serum procalcitonin and endotoxin in the early diagnosis of urosepsis after PCNL . Methods We retrospectively analyzed the clinical data about 427 cases of upper urinary tract stones treated by PCNL , among which urosepsis developed postoperatively in 49 ( the urosepsis group ) and the other 378 non-urosepsis cases served as controls .At 1 day and 2 hours before PCNL , we detected the levels of serum ET and PCT and analyzed the PCT and ET levels and the results of combined detection in the two groups of patients using the ROC curve. Results At 2 hours before surgery , both the levels of PCT and ET were significantly higher in the urosepsis group than in the non-urosepsis controls ([ 5.18 ±4.43 ] vs [ 1.38 ±1.01 ] ng/mL, P<0.01;[50.91 ±35.45] vs [17.86 ±10.78] pg/mL, P<0.01).ROC curve analyses manifested that the areas under the curve (AUC) of PCT and ET were 0.841 ±0.038 and 0.786 ± 0.043, their sensitivities were 79.6%and 71.4%, and their specificities were 78.0%and 70.1%, respectively.The combined de-tection showed the AUC, sensitivity, and specificity to be 0.915 ±0.029, 85.7%, and 86.5%, respectively, all significantly higher than either PCT or ET detection alone (P<0.01). Conclusion The combined detection of PCT and ET can significantly increase the sensitivity and specificity of early diagnosis of urosepsis after PCNL and is superior to either PCT or ET detection alone .

Association between Elevated Alanine Aminotransferase and Urosepsis in Children with Acute Pyelonephritis / 대한소아소화기영양학회지

PURPOSE: The aim of this study is to investigate the association between elevated alanine aminotransferase (ALT) and urosepsis in children with acute pyelonephritis (APN). METHODS: We retrospectively identified all children who were managed in our hospital with APN during a decade period. In our study a diagnosis of APN was defined as having a positive urine culture and a positive (99m)Tc-dimercaptosuccinic acid scintigraphy. We compared those with elevated ALT and those with normal ALT according to the following variables: age, gender, duration of fever prior to admission, presence of hypotension, C-reactive protein (CRP), creatinine, presence of anemia, white blood cells count, platelet count, blood culture result, and grades of vesicoureteral reflux. In addition, the correlation between elevated ALT and positive blood culture was analyzed in detail. RESULTS: A total of 996 children were diagnosed with APN, of which 883 were included in the study. ALT was elevated in 81 children (9.2%). In the analysis of demographic characteristics, the number of children with elevated ALT was higher in children between 0 to 3 months, boys, and in those with positive blood culture (p=0.002, 0.036, and 0.010, respectively). In multivariate analysis of variables associated with positive blood culture, age younger than 3 months, elevated ALT, elevated CRP, and elevated creatinine showed statistical significance (p=0.004, 0.030, 0.043, and 0.044, respectively). CONCLUSION: Our study demonstrates the association between elevated ALT and increased prevalence of urosepsis in addition to elevated CRP, elevated creatinine, and age younger than 3 months in children with APN.

Infección Urinaria en Niños y Niñas internados: Características Clínicas y Microbiológicas

La infección del tracto urinario (ITU) es una de las principales causas de infección bacteriana en niños. Un diagnóstico oportuno, un tratamiento adecuado y un seguimiento estrecho previenen el daño renal crónico. En este trabajo se revisan las características clínicas y microbiológicas de los niños y niñas menores de 15 años ingresados en el Hospital Central de las Fuerzas Armadas (HCFFAA) desde enero de 2011 a noviembre de 2013 mediante la revisión de las historias clínicas. Se encontró un total de 35 casos con aislamiento positivo de urocultivo, donde la Prevalencia se mantiene casi similar, con promedio de 12 casos por año (3% del ingreso hospitalario), la edad más afectada fue la de los lactantes menores de 2 años, el sexo femenino predomina en todas las edades con una relación de 4:1 con respecto a los varones. Los síntomas más frecuentes fueron la fiebre y el vómito. Al igual que en otros estudios la Escherichia coli es el germen de mayor aislamiento y el tratamiento de elección son las cefalosporinas de tercera generación. Tres pacientes han presentado complicaciones, como consecuencia hicieron urosepsis.

Background: Urinary tract infection (UTI) is a major cause of bacterial infection in children. An early diagnosis, appropriate treatment and close monitoring prevent chronic kidney damage. In this study we observed the clinical and microbiological characteristics of children under 15 years admitted to the Central Hospital of the Armed Forces (HCFFAA) from January 2011 to November 2013 by reviewing medical records are reviewed. Materiales y métodos:A total of 35 cases with positive urine culture were isolated, where prevalence remains almost similar, with average of 12 cases per year (3% of hospital admission), it was found the most affected age was that of infants under two years old, females predominate in all age groups with a ratio of 4: 1 with regard to males. The most common symptoms were fever and vomiting. Materiales y métodos:As in other studies the Escherichia coli germ is greater isolation and treatment of choice are the third generation cephalosporin. Three patients have had complications as a result did urosepsis.