Case - Fungal urosepsis after ureteroscopy in a patient on new generation of anti-hyperglycemic medication.

Abstract

Diabetes mellitus is a growing disease with extensive health risks.1 Gliflozin represents a new class of medications in the treatment armamentarium for diabetes. Medications in this class include dapagliflozin, canagliflozin, and empagliflozin. Their primary mechanism of action is blocking sodium-glucose transporter protein 2 (SGLT)-2, which inhibits the reabsorption of glucose in the kidney, and therefore lowers systemic blood sugar levels.2 SGLT-2 inhibitors are known to have higher urinary glucose levels as a byproduct of lowering blood glucose levels. Not surprisingly, patients on gliflozins have an increased incidence of urinary tract infections (UTIs), likely due to the associated glucosuria from the medication.3 Endoscopic urological interventions, particularly ones involving stone treatment, have a well-documented risk for causing UTIs. Prophylactic antibiotics are typically given in accordance with Canadian Urological Association guidelines and local resistance patterns to help reduce the risk of postoperative infections.4 Elevated urinary glucose levels can potentially increase the likelihood of post-endourological procedure infection. Urologists should, therefore, be aware of the higher risk of postoperative infections in patients on these novel agents and tailor their prophylactic antibiotics appropriately. Here, we report a case of a patient with type 2 diabetes mellitus who returned to hospital five days following an uneventful ureteroscopy with sepsis.