Prevalence of and factors associated with atypical presentation in bacteremic urinary tract infection.

A delay in the diagnosis of urinary tract infection (UTI) is not uncommon. Atypical presentation is often cited as one of the causes of diagnostic delays. However, few studies have investigated the prevalence of atypical presentation and determined factors associated with atypical presentation at initial contact among patients with UTI. Therefore, a retrospective and prospective cohort study using chart review was conducted in two acute care hospitals. We included 285 consecutive patients hospitalized for bacteremic UTI. The primary outcome was atypical presentation, defined as the absence of any urinary tract symptom or sign at initial contact. Of all patients, the median age was 82 years, 186 (65.3%) were women, and 53 (18.6%) had dementia. Urinary tract symptoms and signs were absent at initial contact in 144 patients (50.5%; 95% CI 44.7-56.4%). The multivariable analysis revealed that older age, male sex, dementia, and early visit from symptom onset were significantly associated with an increased risk of atypical presentation. Patients with atypical presentation were less likely to receive a correct diagnosis at initial contact than patients with urinary tract symptoms and signs (OR 0.30; 95% CI 0.17-0.51). Atypical presentation in patients with bacteremic UTI is common and negatively affects the correct diagnosis of UTI.

Jejunal Intussusception Caused by a Nasointestinal Ileus Tube.

A 79-year-old man was admitted to our hospital due to pleural empyema. After 4 weeks of antimicrobial therapy and pleural drainage, he recovered but complained of new-onset abdominal pain. Abdominal computed tomography revealed adhesive small bowel obstruction and a nasointestinal ileus tube with intermittent suction was inserted. This procedure initially decreased his abdominal pain, but severe abdominal pain and vomiting developed 3 days later. Repeat abdominal computed tomography revealed jejuno-jejunal intussusception due to the nasointestinal ileus tube. Our patient was initially treated conservatively. However, he underwent surgical reduction due to clinical deterioration 1 day after diagnosis and died from a surgical complication 19 days later. Intussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube in the small intestine. Because urgent operative reduction is needed to avoid intestinal resection in most cases, early diagnosis and surgical reduction of intussusception are critical. LEARNING POINTS: Intussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube.Intussusception should be suspected if abdominal pain and distention worsen after placement of a nasointestinal ileus tube.Urgent operative reduction is needed for intussusception due to a nasointestinal ileus tube.