Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for "Non-infection"

Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.

Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy

We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi.After an uneventful recovery from anaesthesia,the patient developed delirium which manifested as restlessness,agitation,irritability and combative behavior.All other clinical parameters including arterial blood gas,chest X-ray and core temperature were normal and the patient remained haemodynamically stable.But 45 min later the patient developed florid manifestations of septic shock.He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely.There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis,with other clinical parameters remaining normal.Both urosepsis and sepsis associated delirium have very high mortality.High index of suspicion and a protocolized approach in the management of sepsis can save lives.

Urosepsis among Sudanese Patients: A Paradigm from Limited Resources Country

Background: Urosepsis is life-threatening sepsis that leads to organ dysfunction and results from a defective response to a urinary tract infection;the major precipitating is obstructive uropathy in the upper or lower urinary tract (UT). The magnitude and burden of bacteria that caused uropathy were reported to increase annually. In 30% of all septic patients who were diagnosed with urosepsis, 1.5% of them were found in urology and a quarter due to hospital-acquired urinary tract infections (HAUTIs). This study aims to determine the clinical pattern and the frequency of commonly used antibiotics against bacteria associated with urosepsis among Sudanese patients. Methods: This was a cross sectional laboratory-based study, study subjects were recruited from patients attended to Gezira Hospital for Renal diseases and surgery (GHRDS) and was diagnosed, on clinical and laboratory basis, to have urosepsis. Hundred (n = 100) urine samples were collected and inoculated on cysteine lactose electrolyte deficient agar (CLED) media and identify using the suitable biochemical test and performed antimicrobial susceptibility testing (AST) by Kirby Bauer disc diffusion technique for selected antimicrobial agents, according to clinical laboratory standard institute (CLSI) guidelines. Results: Amongst urosepsis infection the frequency of E. coli, S. aureus, Proteus mirabilis, Klebseilla pneumonia and Pseudomonas aeruginosa were (37%, 21%, 10%, 6%, 4% respectively). Resistance to commonly prescribed antibiotics was high, ranging from 17% for meropenem to 100% for cefepime. P. aeruginosa was multidrug resistant compared with other isolates. Conclusions: There was high rate of antibiotic resistance against the common causes of urosepsis in GHRDS, and this reflects the importance of culture and sensitivity test and necessitates adoption of guidelines for selection of suitable antibiotic.

Incidence of Oxa23 and Oxa51 Genes Associated with Bacterial Isolated from Patients with Urosepsis: Single Centre Prespective

Background: Urosepsis is one of the most common infections that require empirical broad spectrum antibiotics immediately after diagnosis. This has led to development of bacterial resistance by acquiring the capability to destroy the β-lactam ring. Methodology: This is a cross-sectional hospital-based study. The study was conducted from 2019 to 2020 at Gezira Hospital for Renal diseases and surgery (GHRDS). A hundred patients were diagnosed clinically with urosepsis and the isolated organisms were Escherichia coli, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumonia and Pseudomonas aeruginosa. The susceptibility test was conducted by Kirby Bauer disc diffusion technique according to clinical laboratory standard institute (CLSI) guidelines. Seventy eight samples of bacterial genomic DNA were confirmed by 16srRNA and multiplex PCR, were performed for genotypic blaOXA-51 and blaOXA-23 gene characterization of isolated bacteria. Then gel electrophoresis was used to identify the presence or absence of (blaOXA-51 and blaOXA-23) genes. Results: 88.5% (69/78) in 16srRNA detected. Using multiplex PCR, the frequencies of blaOXA-51 and blaOXA-23 genes were 13% and 10.1%, respectively. The percentages of isolates which yielded both blaOXA-51 and blaOXA-23 among P. aeruginosa was 25% (1/4), among K. pneumonia was 17% (1/6), and among E. coli was 8% (3/37). Only blaOXA-51 was detected in P. mirabilis 10% (1/10) and only blaOXA-23 was detected in S. aureus 5% (1/18). Conclusion: In this study, the presence of blaOXA-51 and blaOXA-23 genes was increased in the isolated bacteria.

Fatal Urosepsis: A 41 Year-Old Pregnant Woman—Case Report

Introduction: Urinary tract infections are one of the most frequent infectious complications during pregnancy [1], while acute pyelonephritis is the main non-obstetric reason for hospitalisation [2] [3]and septic shock in pregnant women. Objectives and methods: The aim of our study is to analyse the diagnostics and treatment of a 41-year-old pregnant woman with the most severe form of urinary tract infection—urosepsis. Case report: A 41-year old woman in the 12th week of pregnancy hospitalised at Intensive Care Unit (ICU) after urological intervention (JJ stent). On the first day after the intervention, the patient was diagnosed as having urosepsis. Scores: SOFA 14 pts, APACHE II 26 pts, SAPS II SCORE 61 pts. Second day in ICU: spontaneous abortion. Microbiological?investigation: Escherichia coli—extended-spectrum beta-lactamase (ESBL+). Conclusions: Apregnant patient with a complicated infection of the urinary system ought to be treated in a multi-profile hospital, offering a possibility to consult doctors of various specialisations (urologist, gynaecologist, anaesthesiologist, nephrologist) as well as full access to a radiology laboratory, which will ensure the choice of appropriate and safe treatment for both the mother and the developing foetus.

Comparative Study of Urosepsis-Associated Escherichia coli in Tertiary Care University Hospital in the Central Region of Japan from 2008 to 2011

Escherichia coli infection is important cause of morbidity and mortality. Urosepsis is most commonly caused by Escherichia coli. It is generally reported to have low mortality rates and favorable outcomes compared with sepsis induced in other organ/ system or tissues. This study was conducted to find out the clinical characteristics of urosepsis-associated Escherichia coli isolates at tertiary care university hospital in the central region of Japan from 2008 to 2011. Escherichia coli was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. We analyzed the relationship between medical records appended to clinical species and bacterial data by using a statistical method. Of one hundred five Escherichia coli, fifty-three were from urosepsis and fifty-two were from other disease. The ratio of male to female from urosepsis tended to be lower than that from others. Forty-two isolates were from outpatient and sixty-three were from inpatient. The ratio of inpatient to outpatient from urosepsis was significant lower than that from others. With respect to age, the numbers of elder patients were higher than those of others. Most of the Escherichia coli isolates were from the emergency room followed by urology, and general medicine. The ratio of urosepsis to no urosepsis at urology department was significant higher than that at other departments. With respect to antimicrobial susceptible pattern, the ratio of urosepsis to no urosepsis about only aztreonam resistant was significant higher than that about other antibiotics. We need enough attention to be paid to urosepsis, especially female and elder patients.

Value of urine IL-8, NGAL and KIM-1 for the early diagnosis of acute kidney injury in patients with ureteroscopic lithotripsy related urosepsis

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.

Differential protein expression in patients with urosepsis

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, SERPINC1 and 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.)

Non-Neutropenic Sepsis in Cancer Patients: The Luminal Obstruction Syndrome

Background: Neutropenic sepsis is a frequent complication of cytotoxic chemotherapy delivered for cancer patients. Its management is well determined by clinical guidelines. Non-neutropenic sepsis is another potential complication in cancer patients. Its management is less established in the medical literature. Materials and Methods: Three cases are presented to illustrate favourable evolution of non-neutropenic biliary-, uro- and bronchogenic-sepsis in cancer patients with poor prognosis. Results: All three patients had a survival over six months after the management of the septic complication. Two of them received subsequent systemic anticancer treatment. Conclusions: Survival benefit offered by the management of cancer-related non-neutropenic sepsis may be comparable to the benefit obtained by systemic anticancer treatments. Cost-effectiveness of sepsis management may be better than that of anticancer treatments.

Bacterial Urinary Tract Infections among Males with Lower Urinary Tract Obstruction at Komfo Anokye Teaching Hos-pital, Kumasi, Ghana

Purpose: We describe the commonest pathology responsible for lower urinary tract obstruction (LUTO) and associated symptoms such as UTI, etc. among males at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Materials and Methods: Between January and December 2009, prospective cross sectional hospital based study was conducted involving 103 subjects. Patients with symptoms of LUTO and who were on short admission (up to 48 hours) at the accident and emergency unit of KATH were identified as potential study subjects. All the patients presented with acute retention of urine at the emergency unit of KATH and urethral catheterization was attempted to relieve them of the retention under sterile conditions. Those patients whose initial catheterization failed went through suprapubic cystostomy (suprapubic catheterization). Urine specimens for culture and sensitivity tests were then collected into sterile urine containers immediately after the catheterization (irrespective of type). Ultrasound Scan was requested for all the patients to assist in diagnosing enlargement of the prostate and other associated urological pathologies. Retrograde urethrogram was however, requested for those patients with suprapubic catheterization and which helped in the diagnosis of the urethral stricture. For a particular child, urethral catheter was passed under sterile condition and Micturicting Cysto-Urethrogram (MCUG) was done to assist in diagnosing posterior urethral valve and other conditions. Those subjects whose urinalysis revealed pyuria and positive urine culture and who had voluntarily agreed to enter the study were enrolled. Subjects whose urine culture had multiple bacteria growth that was deemed to be contaminants were excluded from the study. Results: The mean age for males with LUTO was 62 years. The youngest male with LUTO was aged 2 years whilst the maximum age was 93 years. LUTO due to prostatic hyperplasia was found in 79 (76.7%) men;23 (22.3%) had LUTO due to urethral stricture and 1 (1.0%) (youngest male). The mean age of patients that had LUTO due to urethral stricture was approximately 39 years. The youngest patient with LUTO due to urethral stricture aged 22 years whilst the maximum age was 72 years. Microbiological results indicated that Escherichia coli caused 53 (51.5%) of urinary tract infection (UTI) due to LUTO;Klebsiella = 23 (22.3%);Staphylococcus aureus = 14 (14.6%);Pseudomonas spp. = 8 (7.8%) Proteus = 2 (2.0%);Citrobacter = 1 (1.0%) and Salmonella spp. =1 (1.0%). Conclusion: The most common cause of lower urinary tract obstruction (LUTO) in Kumasi, Ghana is prostatic hyperplasia and the commonest causative organism of the associated UTI symptom is Escherichia coli.

Spectrum of Bladder Cancer Patients Morbidity and Mortality in a Tertiary Hospital of Northwestern Nigeria: A 7-Year Review

Background: Bladder cancer is a common cause of morbidity and mortality in our institution due to the late presentation. Morbidity is defined as a development of complications that may lead to mortality. Uraemia is a common presentation that constitutes a management challenge in our patients. We study the spectrum of morbidity and mortality in bladder cancer patients in our institution. Materials and Methods: This is a retrospective study of patients with clinical, radiological, cytological and or histological features of bladder cancer that had a morbidity and or mortality managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2011 to December, 2017. Data were retrieved from patients’ case notes via a proforma and analyzed using SPSS 20.0 version for windows. The results were presented in number percent, tables and chart. Results: There were morbidity and or mortality in 234 bladder cancer patients within the study period with a mean age of 48.4 ± 14.1 years and a range of 3 - 106 years. There were 219 males (91.5%) and 20 females (8.5%) with a male to female ratio of 11:1. There were haematuria and lower urinary tract symptoms (LUTS) in 230 patients (98.3%). There were necroturia ± weight loss and anorexia in 126 patients (53.8%). There was urinary tract infection (UTI) in 75 patients (32.1%), anaemia in 131 patients (56.0%) and uraemia in 161 patients (68.8%). Mortality was recorded in 84 patients (35.9%) which was due to uraemia in 52 patients (22.2%), urosepsis in 22 patients (9.4%) and anaemia in 8 patients (3.4%), intestinal obstruction and blood transfusion reaction in 1 patient each (0.4%). Conclusion: Anaemia, urosepsis and uraemia are the most common causes of morbidity and or mortality in bladder tumour patients in Sokoto. This poses great diagnostic and therapeutic dilemma to the urologist, patients and their relatives.

A case of follicular cystitis treated successfully with diethylcarbamazine

Follicular cystitis is a non-specific inflammatory condition of the bladder where the aetiology is unknown.The extent of the disease can be mild or proliferative and bulky.Antibiotics,steroids,therapies used for interstitial cystitis,palliative cystectomy and radiotherapy have been reported as successful treatment options.We report a case of follicular cystitis that responded to a course of oral diethyl carbamazine.

Disseminated osteomyelitis after urinary tract infection in immunocompetent adult:A case report

BACKGROUND Urinary tract infection(UTI)is one of the most common bacterial infections.Acute pyelonephritis or upper urinary tract infection is often accompanied by bacteremia;however,bacteremia resolves in most cases without complication.Rarely,complications due to bacteremia occur.One of these is osteomyelitis.It mainly affects the lumbar vertebral bodies,and rarely affects other site.CASE SUMMARY An 80-year-old woman presented to the hospital with a two-month history of pain in both legs.Two months ago,she was admitted to the hospital for fever,flank pain,and urinary frequency and was diagnosed with bacteremic UTI.During hospitalization,she complained of pain in both legs;however,the pain resolved shortly after,and no abnormalities were observed on physical examination.Therefore,she was placed on 2-wk antibiotic therapy for UTI without further evaluation for leg pain.However,pain recurred after discharge and persisted;therefore,an imaging test was performed.Bone scan and magnetic resonance imaging suggested osseous infection in both femurs,tibiae and patellae.Surgical treatment was performed,and tissue-and bone cultures revealed Escherichia coli,a previously observed pathogen,which demonstrated same antibiotic sensitivities,as noted in previous UTI.She was diagnosed with disseminated osteomyelitis,as a complication of UTI,and was placed on an 8-wk antibiotic therapy.CONCLUSION Indication for osteomyelitis should be high regardless of bone pain at sites other than lumbar spine after or during UTI.

Clino-Pathological Features of Urinary Tract Infection in Rural India

The study was aimed to understand the clino-pathological characteristics of urinary tract infection along with the techniques used in diagnosis and treatment of the presenting infection. The study takes into consideration the various risk factors such as age, sex, and diabetes mellitus which can precipitate a urinary tract infection. The study was conducted at the Global Baroda Hospital, Vadodara and Narhari Hospital, Vadodara in the duration from January to March 2012, under the supervision of Dr. Hiten Kareliya. A questionnaire was prepared in accordance to evaluate risk factors of urinary tract infection. The patients under study were chosen according to specific inclusion criteria. The uropathogens were isolated with the help of biochemical testing. E. coli (38%) was found to be the most prevalent organism followed by Klebsiella and Candida albicans (both 10%), Pseudomonas aeruginosa (9%), Staphylococcus (7%).

Bedside emergency surgical decompression and venoarterial extra-corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy-induced arrest:A case report

Background:Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients.Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra-corporeal membrane oxygenation(ECMO).In cases where obstructive uropathies lead to urosepsis,emergent decompression with double-J(D-J)stenting may be necessitated. Case Presentation:We report the case of a 72-year-old woman who arrived at the emergency department and rapidly deteriorated into a state of shock.During the process of resuscitation,emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction.She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation.Given the suspected diagnosis,it was decided that an emergent bedside digital disposable flexible ureteroscopy(ddFURS)and D-J catheterization to be performed as rescue decompression procedure.The patient was suc-cessfully stabilized with received antibiotic and continuous renal replace-ment therapy(CRRT)before being transferred to the cardiology department to correct her arrhythmia.She was weaned off CRRT and was able to walk without the need of aids upon discharge. Conclusion:Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure.Emergent decompression with ddFURS and D-J stenting can be performed effectively even in a patient with venoarterial ECMO for res-cuing uroseptic cardiomyopathy-induced arrest secondary to obstructive uropathy.Short-term outcomes were favorable.However,long-term prog-nosis remains to be elucidated.