Case Of Cystitis Research Articles

A Case of Eosinophilic Cystitis treated with Mepolizumab

Background: Eosinophilic cystitis is a rare inflammatory cystitis of unknown origin. Common symptoms include urinary frequency, urgency, pain, and recurrent urinary tract infections. Currently used treatments include corticosteroids, anti-inflammatory drugs, antihistamines, and antibiotics. Here we present a case of successful treatment of eosinophilic cystitis with mepolizumab. Case Presentation: A 41-year-old female presented with urinary frequency, urgency, and suprapubic pain. She underwent multiple tests including cystoscopy and biopsy, which revealed a diagnosis of eosinophilic cystitis in 2000. She was initially managed with oral antihistamines and oral steroids. However, over the years her symptoms increased in frequency, intensity, and duration. Montelukast 10 mg daily started which did not show any improvement. In 2017 Mepolizumab 100 mg every 4 weeks started. The patient noted improvement after a few months, and she was tolerating her injections well without side effects and had no further flares of her condition. Discussion: We present a case of eosinophilic cystitis which was refractory to multiple treatments and responded well to mepolizumab. There are no definite guidelines for the management of EC and there is no curative treatment for this disease. Mepolizumab is an anti-IL-5 monoclonal antibody and the use of mepolizumab in the management of EC that is refractory to treatment have been reported in a few cases. The use of mepolizumab has been described in different diseases associated with eosinophilic inflammation such as severe eosinophilic asthma, eosinophilic esophagitis, eosinophilic chronic obstructive pulmonary disease, and severe nasal polyposis. Conclusion: Mepolizumab can be considered a treatment option in EC cases refractory to the standard treatment. At this time, larger studies are needed to evaluate the efficacy and safety of mepolizumab in EC.

Emphysematous cystitis in feline caused by <em>klebsiella oxytoca</em> multi-resistant producer of extended spectrum betalactamases associated with <em>enterococcus</em> sp. - case report

Over the years, resistance to antimicrobials has become one of the world's biggest public health problems. This problem deserves attention not only in medicine but also in veterinary medicine since microorganisms have zoonotic potential. For that reason, this study aims to report a case of feline emphysematous cystitis caused by a multiresistant Klebsiella oxytoca Extended Spectrum Beta-lactamase (ESBL) producer associated with an Enterococcus sp. We treated the animal at the Veterinary Hospital of the Universidade Federal de Mato Grosso, campus Sinop, Mato Grosso, Brazil and the microorganisms were identified by employing morphotintorial characteristics and biochemical tests at the Animal Health Laboratory of the same institution. We performed the antimicrobial sensitivity test using the Kirby and Bauer method, where we identified resistance to several antimicrobial classes. For phenotypic detection of ESBL production in the Klebsiella oxytoca strain, we performed Disk Approximation, Three-dimensional Extract Test and Minimum Inhibitory Concentration tests using the Etest® tape. This case draws attention because they are bacteria commonly isolated in nosocomial infections in humans only and, for that reason, it emphasizes the importance of working with antimicrobial resistance in the concept of One Health

EOSINOPHILIC CYSTITIS IN A PEDIATRIC PATIENT WITH X-LINKED CHRONIC GRANULOMATOUS DISEASE

<h3>Introduction</h3> Pediatric Eosinophilic Cystitis is an uncommon inflammatory disease associated with X-linked Chronic Granulomatous Disease (X-CGD)¹. We present a rare case of a teenage patient with refractory eosinophilic cystitis. <h3>Case Description</h3> Patient is a 14-year-old male with X-CGD, colitis, and complications from chronic steroid use, including bilateral cataracts, osteoporosis, and adrenal insufficiency. His colitis was well-controlled with vedolizumab when he presented for evaluation of new onset dysuria and intermittent scrotal pain that improved with voiding. Infectious workup was unrevealing. CT of abdomen and pelvis demonstrated asymmetric, irregular thickening, nodularity and enhancement of the left bladder wall and bladder base. Pathology from cystoscopy was significant for scattered eosinophils, suspicious for eosinophilic cystitis. He demonstrated mild peripheral eosinophilia (0.63 K/µL). He was started on intravesical dexamethasone 10mg, to minimize complications from systemic steroid use, and oral loratadine 5mg on intravesical treatment days. However, his symptoms did not resolve and intravesical dexamethasone was increased to 25mg then to 50mg. Loratadine was increased to 10mg daily. His bladder ultrasound normalized after 12 doses of intravesical dexamethasone and daily 10mg loratadine. Three weeks after loratadine was weaned to every other day, his urinary symptoms returned. Loratadine was increased to 10mg daily and he remained asymptomatic off steroids. <h3>Discussion</h3> Reported cases of pediatric eosinophilic cystitis are mostly in young children, only requiring a short course of intravesical steroids and oral antihistamine, unlike our patient^2,3. More research is needed to elucidate the history, optimal diagnosis and guide appropriate management of eosinophilic cystitis in pediatric X-CGD patients.

A study of uropathogenic Escherichia coli from men in regional NSW (Australia) with special emphasis on antibiotic resistance

Background: Escherichia coli is an important uropathogen, responsible for most urinary tract infections (UTIs). Most studies on E. coli UTI pathogenesis have been in females, with limited studies on urinary isolates from men. Understanding UTI epidemiology in men is important in UTI management in this gender, including formulation of empirical treatment guidelines. Methods: We studied the distribution of 310 uropathogenic E. coli isolates from men by uro-clinical syndrome, hospitalisation status, age group, and antibiotic susceptibility. Results: Most of the E. coli isolates were from the outpatient setting (189, 61%), with the various age groups generally evenly distributed. In the inpatient setting, the 0-10 years age group was not represented, and the remaining 3 age groups were evenly represented (22-27%). Most of the isolates (74%) were from cystitis cases. For pyelonephritis isolates, the majority (65%) were confined to the 21-40 years age group, and the least in the 11-20 years age group (12%). Antibiotic (and multidrug) resistance was higher in pyelonephritis vs. cystitis isolates (73% vs. 58% ; P = 0.023, for multidrug resistance). Overall, antibiotic resistance differed significantly by age; highest in the 21-40 years age range (69%), and lowest in the 0-10 years group (39%). Likewise, ESBL production was highest in the 21-40 years age range (10%), and lowest in the 0-10 years age (0%). Conclusion: We documented a significant difference in the distribution of antibiotic resistance by age group amongst UPEC isolates from men in regional NSW, Australia, in the 0-60 years age group.

Complex therapy of recurrent urinary infections

Recurrent urinary tract infections (RUTI) occur in 10-15 % of women of reproductive age and in 20 % of menopausal women and have an extremely negative impact on quality of life. Urinary tract infections (UTIs) account for about 40 % of all hospital-acquired infections and 50% of bacterial infections resulting in long-term hospitalisation. In Russia, 26-36 million cases of acute cystitis are reported each year. Because of its high prevalence, UTI is an economic problem. Clinically, UTI is more often manifested as acute urethritis or cystitis. Antibiotic therapy is a fundamental treatment for RUTI, but has a number of negative consequences. Antimicrobial resistance is an enormous challenge and a serious threat to global health, prompting the search for alternative strategies. Natural antimicrobial peptides have attracted the attention of researchers and clinicians for their broad therapeutic potential against bacteria, viruses and resistant intracellular bacterial communities (biofilms). This review details the etiology, classification, diagnosis and therapy of RUTI. Global data revealing the mechanisms of action of antimicrobial peptides is presented. Commercially available peptide-based antimicrobials and their efficacy based on clinical trials are discussed. The development of new strategies to combat bacterial infections, in particular the use of drugs based on antimicrobial peptides and their derivatives, has been shown to be of great practical importance in terms of combating multidrug-resistant pathogens and increasing the effectiveness of treatment of recurrent infections.

Overview of the causes and types of recurrent cystitis

Bacterial cystitis accounts for the majority of urinary tract infection (UTI). It is frequently found in young, otherwise healthy females showing no signs of anatomical or physiological urinary tract defects. Among young women who have experienced an episode of acute bacterial cystitis, 25% to 50% develop recurrent episodes. Individuals with recurrent cystitis episodes have a greater susceptibility to urogenital colonization with uropathogens that thrive by adhering to uroepithelial cells. Further, there is an increased likelihood of infection with an antibiotic resistant uropathogen due to previous antimicrobial therapy for recurring infections. At each step of the pathogenesis, different host genetic, biologic, and behavioral factors, and bacterial factors interact and influence susceptibility to recurrent cystitis. Behavioral factors like sexual intercourse, use of spermicidal contraceptives and history of recurrent cystitis are major independent risk factors for recurrent cystitis infections. In post-menopausal women without comorbidities, estrogen depletion is mainly responsible for increased susceptibility to recurrent cystitis. Certain strain-specific bacterial virulence determinants may also contribute to recurrent cystitis by providing a selective advantage. Phenotypically, recurrent cystitis is categorized as reinfection or bacterial persistence. Majority of recurrent cystitis cases seen in men occur due to structural or functional abnormalities of the urinary bladder which allows same pathogens from the same site in the bladder to cause recurrences due to bacterial persistence. The concept of ‘uncomplicated’ and ‘complicated’ recurrent cystitis is used for classification of recurrent cystitis cases, similar to UTIs. Uncomplicated recurrent cystitis comprises cases occurring in young, healthy, nonpregnant women, mainly due to uropathogenic Escherichia coli. Due to the unique spectrum of host-bacterial interactions in the urinary tract, the distinction between complicated and uncomplicated recurrent cystitis is not straightforward. ‘Complicating’ factors such as structural, obstructive, neoplastic, functional, and neurological abnormalities of the urinary tract, systemic conditions including pregnancy, and certain demographic factors are attributed in the development of complicated recurrent bacterial cystitis.

Assessment of survivin and p27 expression as potential prognostic markers in urothelial cell carcinoma of urinary bladder in Egyptian patients

BackgroundBladder cancer (BC) is the tenth most common cancer worldwide with urothelial carcinoma (UC) being the main histologic subtype. Survivin is an apoptosis inhibitor that is associated with tumor proliferation and invasion. P27 is a cyclin-dependent kinase inhibitor that negatively regulates cell proliferation. The expression of both proteins was variable among different solid tumors including UC.MethodsWe aimed to investigate the expression of survivin and P27 in UC of urinary bladder and correlate their expressions with histopathological parameters in an attempt at studying the possibility of their use as targeted therapies. The investigation was performed through immunohistochemical staining for both proteins on sections belonging to 60 UCs and 12 mild chronic cystitis cases (controls). Immunopositivity (number of positive cases) and expression score (percentage of positive urothelial cells) were evaluated.ResultsBoth survivin and P27 were absent in urothelial cells of mild chronic cystitis lesions while expressed in 60% and 43.3% of UCs, respectively. High score of survivin and low score of P27 were associated with poor prognostic factors of UC (solid pattern, high grade, and deep tumors). By logistic regression test, survivin expression can be a predictive risk factor associated with solid pattern and high-grade UC, while P27 expression can be a predictive risk factor associated low-grade UC.ConclusionHigh survivin and low P27 expression scores were associated with the studied prognostic factors of UC. Both proteins may play a role in UC progression and can have a value as prognostic and/or diagnostic markers of UC, as well as targeted therapies.

Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies.

Urinary tract infections, especially cystitis, are common infections; they are the second most prevalent cause of antibiotic prescriptions in community pharmacies. To reduce antimicrobial resistance, guidelines are revised regularly. This study aims to assess compliance between prescriptions collected in community pharmacies and French cystitis guidelines. A treatment is considered compliant if the nature, dosage, and duration of the antibiotics are correct. Only women aged 18–65 years with a diagnosis of cystitis were eligible. The participation of 16 pharmacies resulted in 303 prescriptions. Most infections were classified as uncomplicated cystitis (79.2%), general practitioners were the prescribers in more than 9 out of 10 cases, and fosfomycin trometamol was the antibiotic dispensed for 1 in 2 women. An average compliance of 66% was observed, but with disparities according to the type of cystitis. Two-thirds of cases of uncomplicated cystitis and recurrent cystitis followed the recommendations, whereas only 15% of cystitis cases that were at risk of complication did so. The inclusion of a urine examination in uncomplicated cystitis decreased the overall compliance rate to 5.8%. These results show the essential role played by pharmacists; they are the last line of defence before dispensing antibiotics. They must know the recommendations in order to apply them.

Severe hemorrhage in patient carrier of diabetes mellitus type 2 with emphysematous cystitis: a case report and literature review / Hemorragia grave em doente portador de diabetes mellitus tipo 2 com cistite enfisematosa: um relatório de caso e revisão de literatura

Background: Emphysematous cystitis is a disease of the bladder with retention of gas in the bladder wall or lumen. The risk factors include urinary tract infection by gas producing anaerobic bacteria and fungi, diabetes mellitus and compromised immunity. Primary risk factor being diabetes mellitus, emphysematous cystitis can occur with unsual presentations like hypervolemic shock. Imaging technologies are widely used to diagnose and detect emphysematous cystitis. However, better diagnosis can be achieved by computed tomography (CT) of the abdomen and pelvis. Early and accurate diagnosis of emphysematous cystitis in diabetic patients can result in better prognosis of the disease.Case presentation: Here, we report for the first time a case of emphysematous cystitis with hypovolemic shock with type 2 diabetes mellitus, and present a review of literature on the topic. The diabetic patients with emphysematous cystitis should be cautiously monitored for hypervolemic shock along with the routine management of the disease. Conclusions: Such patients should be kept on constant monitoring for hypervolemic shock along with conventional diagnosis and management of the disease.

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Eosinophilic cystitis complicated with cystitis glandularis: a case report

BackgroundEosinophilic cystitis (EC) is a rare inflammatory disease characterized by the gathering and infiltration of numerous eosinophilia (EOS) in the bladder wall. Because of Few cases of EC have been reported globally, the epidemiology of EC is not well known. We report herein the details of one very scarce case of large tumor-like eosinophilic cystitis complicated with cystitis glandularis (CG) diagnosed by biopsy.Case presentationA 45-year-old Chinese man was referred to our hospital for the treatment of right lumbago and odynuria. Ultrasound examination indicated the low echo on the right portion wall and the neck of the bladder. Computed tomography showed a remarkable enhancing large mass that measured 5.0 cm × 2.3 cm located on the right portion of the bladder with undefined margin. For further treatment, diagnostic transurethral resection of the bladder was performed, the postoperative histopathological diagnosis was EC complicated with CG. After transurethral resection, antibiotics, glucocorticoids, and antihistamines were treated. The patient recovered uneventfully and was discharged on postoperative day 8 without evidence of recurrence followed-up for 6 months.ConclusionLarge tumor-like eosinophilic cystitis complicated with cystitis glandularis is rare, malignant tumors need to be ruled out. We deem that prompt biopsy led to the exact diagnosis, appropriate treatment led to better prognosis.

Refractory bladder haemorrhage managed with cystoscopic diathermy in a patient with Ataxia-Telangiectasia and intercurrent BK polyomavirus infection

Ataxia telangiectasia (A-T) is a rare neurodegenerative immunodeficiency syndrome, characterised eponymously by progressive cerebellar ataxia and telangiectatic vessels, most often cutaneous. A-T displays autosomal recessive inheritance, is characterised by defective DNA repair due to mutations within the ATM gene on chromosome 11 [ 1 ]; and a lack of native ATM protein gives rise to the aforementioned hallmarks of the disease. With A-T comes a predisposition to haematological malignancy and humoral immunodeficiency, and as such these patients often suffer truncated lifespans [ 1 , 2 ]. Urological manifestations are rare, and intravesical involvement comprising bladder telangiectasia has only been described in a handful of cases, all of which have previously been treated with cyclophosphamide for malignancies, a known instigator of bladder haemorrhage [ [3] , [4] , [5] ]. Similarly, BK polyomavirus is a known precipitant of nephropathy and haemorrhagic cystitis in actively immunosuppressed renal transplant patients, though has not been established as such in genetically immunodeficient patients with native urological tissue [ 6 ]. Here we present, to our knowledge, the first case of refractory haemorrhagic cystitis in an A-T patient with intercurrent BK polyoma virus infection, who had previously been treated with cyclophosphamide for leukaemia, and propose that recurrent cystoscopic diathermy is a robust and relatively conservative surgical option to treat haemorrhagic cystitis secondary to bladder wall telangiectasia.

"Slim-Mesh" Technique for Giant Ventral Hernia.

Background and Objective:We devised a sutureless “Slim-Mesh” technique to treat ventral hernias, including large-giant/massive ones, reduce intra- and postoperative complications, and lower operation time.Methods:Between September 1, 2009 and October 31, 2020, 43 patients with large (10 – 14.9 cm)-giant (15 – 19.9 cm) and massive (≥ 20 cm) ventral hernia were operated at our Department with the above technique. This was a prospective (79%)-retrospective study.Results:This study comprised 22 males and 21 females. Mean age was 63 years. Large-giant and massive hernias were found intraoperatively in 37 and 6 cases respectively. Mean operation time for all hernias was 116 minutes, 104 for large-giant hernias, and 190 for massive. In 53.4% of cases, hernia-neck operative measurement was larger than preoperative size. In 25.5% of cases, laparoscopy found satellite hernias previously undetected by ultrasound- and/or computed tomography scan. A composite mesh and a noncomposite mesh were used in 95% and 5% of cases respectively. For mesh fixation, titanium tacks and absorbable straps were used in 14% and 86% of cases respectively. Mean length of hospital stay was 2.3 days. Mean follow-up time was 3 years and 4 months. In our study, there were 5 early postoperative complications: 3 seromas, 1 trocar-site hernia, and 1 case of cystitis. We found 2 late small symptomless recurrences (4.6%).Conclusion:The sutureless “Slim-Mesh” technique facilitates intra-abdominal introduction, as well as the handling and fixation of giant and monster (36 × 26 cm) meshes. In our experience, “Slim-Mesh” is safe, simple, and fast, and economical even for large-giant/massive ventral hernia repair.

A Case of Hemorrhagic Cystitis that Developed During Administration of Cyclophosphamide for Idiopathic Thrombocytopenic Purpura Successfully Treated with Kamikihito

症例は71歳女性。主訴は肉眼的血尿。近医にて特発性血小板減少性紫斑病（ITP）に対し，シクロフォスファミド50mg/day 投与中，肉眼的血尿が続くため，当科紹介受診。膀胱鏡にて膀胱内に粘膜不整あり，膀胱癌の疑いで経尿道的膀胱腫瘍切除（TURBT）施行。病理結果は polypoid cyst で出血性膀胱炎と診断した。2ヵ月後より再び血尿出現，猪苓湯合四物湯および柴苓湯を投与したがいずれも無効だった。漢方所見から気虚・血虚，および ITP を考慮し，加味帰脾湯を投与すると，約1ヵ月で肉眼的血尿は消失，尿沈査も RBC1-4/HPF と正常となった。1年後の膀胱鏡でも膀胱腫瘍を疑い，再度 TUR-BT を行ったが，病理結果は Inflammatory change であった。以後44ヵ月の観察期間に加味帰脾湯を継続し，肉眼的血尿は見られなかった。

Emphysematous cystitis due to Streptococcus salivarius infection in a patient with a neurogenic bladder

Streptococcus salivarius (S. salivarius) is an oral commensal bacterium that rarely causes disease. Here, we report a case of emphysematous cystitis due to S. salivarius infection in a patient with a neurogenic bladder. A 56-year-old woman was hospitalized and managed for left putamen hemorrhage. Afterward, she developed poor oral intake. Although the patient was afebrile, laboratory test results suggested an inflammatory response. Urinalysis revealed pyuria and hematuria. Abdominal computed tomography revealed a thickened urinary bladder wall and intraluminal gas. Additionally, she was diagnosed with a neurogenic bladder as she had approximately 200 mL of residual urine. The patient was diagnosed with emphysematous cystitis, and S. salivarius was isolated from urine culture specimens. The patient’s condition improved immediately after treatment, which included bladder drainage and administration of appropriate antibiotics. We could not find any report on S. salivarius causing urinary tract infections, such as emphysematous cystitis. Accordingly, we report this case along with a review of the literature.

Medication use quality and safety in older adults: 2020 update.

Improving the quality of medication use and medication safety are important priorities for prescribers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2020. We selected high-quality studies that moved the field of research forward and were not merely replication studies. The chosen articles cover domains related to deprescribing, medication safety, and optimizing medication use. The first study, a noninferiority randomized clinical trial in England, evaluated whether antihypertensive medication reduction is possible without significant changes in systolic blood pressure control or adverse events over the 12-week follow-up (domain: deprescribing). The second study, a prospective cohort study of women at Kaiser Permanente Southern, California, examined the association between bisphosphonate use and atypical femur fracture (domain: medication safety). The third study examined the effectiveness and safety of a multifaceted antimicrobial stewardship and quality improvement initiative in reducing unnecessary antimicrobial use for unlikely cystitis cases in noncatheterized residents in 25 nursing homes across the United States (domain: optimizing medication use). Lastly, the fourth study, a population-based cohort study in the United Kingdom, examined the association of tramadol use with risk of hip fracture (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.

97. Pharmacist Driven Antimicrobial Stewardship Interventions on the Management of Urinary Tract Infections in the Emergency Department at a Tertiary Military Treatment Facility

BackgroundWith the Joint Commission standards targeting ambulatory settings serving as a catalyst, we designed a quality improvement (QI) project was designed to evaluate the existing management and prescribing patterns for urinary tract infections (UTI) in the Walter Reed National Military Medical Center (WRNMMC) Emergency Department (ED) in order to identify targets for ASP intervention. MethodsThis was a Pharmacist-driven, prospective, QI project conducted over a 3-month period. The clinical presentations and microbiological data of uncomplicated cystitis and pyelonephritis cases managed in the ED were reviewed. Within 24-72 hours of ED discharge, recommendations were relayed to both patients and ED staff. Diagnostic criteria and management concordant with established clinical guidelines were assessed. Inclusion criteria included age ≥ 18, admission status, urine culture and antibiotics for UTI or pyelonephritis.ResultsA daily urinalysis (UA) report identified 1781 ED encounters of which 117 cases met inclusion criteria. Nitrofurantoin was most prescribed empirically at 39.3% followed by a cephalosporin (23.1%) or a fluoroquinolone (19.7%), accounting for 32% of inappropriate empiric antibiotic selection. Cases were identified with inappropriate duration of therapy (22.2%), dosage (9.4%), and drug-bug mismatch (9.4%). Nearly 38% of cases required intervention to discontinue (32.5%) or initiate new antibiotics (3.4%). Diagnostic concordance was defined as having positive urinary symptoms, clinically significant UA and positive urine culture. This was only observed in 37.6% of all cases, of which only 43.2% were treated with a guideline concordant empiric regimen, dosage and duration of therapy. Although not included in the final analysis, it was noted 916 urine culture results were ordered where 70% were not associated with genitourinary complaints or sepsis.ConclusionDespite guidelines for UTI management, considerable practice discordance was found in the ED. Multiple Pharmacist targeted interventions were identified. Prioritized areas for ED provider education include first-line therapy, treatment duration, and diagnostic stewardship. This QI project has potential for optimizing prescribing practices in Military Health System ambulatory settings. Disclosures All Authors: No reported disclosures

Molecular Epidemiology of Multidrug-Resistant Uropathogenic Escherichia coli O25b Strains Associated with Complicated Urinary Tract Infection in Children.

Background: Uropathogenic Escherichia coli (UPEC) has increased the incidence of urinary tract infection (UTI). It is the cause of more than 80% of community-acquired cystitis cases and more than 70% of uncomplicated acute pyelonephritis cases. Aim: The present study describes the molecular epidemiology of UPEC O25b clinical strains based on their resistance profiles, virulence genes, and genetic diversity. Methods: Resistance profiles were identified using the Kirby–Bauer method, including the phenotypic production of extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs). The UPEC serogroups, phylogenetic groups, virulence genes, and integrons were determined via multiplex PCR. Genetic diversity was established using pulsed-field gel electrophoresis (PFGE), and sequence type (ST) was determined via multilocus sequence typing (MLST). Results: UPEC strains (n = 126) from hospitalized children with complicated UTIs (cUTIs) were identified as O25b, of which 41.27% were multidrug resistant (MDR) and 15.87% were extensively drug resistant (XDR). The O25b strains harbored the fimH (95.23%), csgA (91.26%), papGII (80.95%), chuA (95.23%), iutD (88.09%), satA (84.92%), and intl1 (47.61%) genes. Moreover, 64.28% were producers of ESBLs and had high genetic diversity. ST131 (63.63%) was associated primarily with phylogenetic group B2, and ST69 (100%) was associated primarily with phylogenetic group D. Conclusion: UPEC O25b/ST131 harbors a wide genetic diversity of virulence and resistance genes, which contribute to cUTIs in pediatrics.

Intravesical alprostadil as a promising agent in BK virus-associated hemorrhagic cystitis: A report of a refractory case.

Allogeneic stem cell transplant recipients are at risk of BK virus-associated hemorrhagic cystitis. This condition causes a significant morbidity and worsens clinical outcomes. The standard cares for BK virus-associated hemorrhagic cystitis are saline irrigation and forced diuresis. Notably, several beneficial roles are proposed for antiviral and anti-inflammatory agents against BK virus-associated hemorrhagic cystitis. However, cases who are at risk of cystectomy remain refractory. Herein, we present a 13-year-old boy with severe hematuria by passing two months from his allogeneic stem cell transplantation. The laboratory work up showed high BK viremia >1.1 × 108 copies/ml in this case's urine sample. The patient was treated with antiviral agents in combination with supportive care. Moreover, intravesical alum was administered, but no clinical benefits were achieved. Finally, intravesical alprostadil was prepared under the supervision of a pediatric clinical pharmacist. In this regard, an alprostadil solution was prepared by constitution of 250 μg alprostadil in 50 mL saline. After administrating the first dose of intravesical alprostadil, an acceptable clinical response was observed, and hematuria stopped. Of note, alprostadil induces platelet aggregation and vasoconstriction. Thus, bleeding can be controlled after the administration of intravesical alprostadil. This strategy may be associated with several side effects including bladder spasm. This study is the first report describing the special role of intravesical alprostadil in refractory cases of BK virus-associated hemorrhagic cystitis. In such refractory cases, clinicians can use intravesical alprostadil rather than invasive therapies in the treatment of BK virus-hemorrhagic cystitis.

AIR WHERE IT SHOULDN'T BE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Emphysematous cystitis is a relatively rare and potentially fatal disease characterized by gas in the bladder primarily observed in diabetic middle aged women. Clinical symptoms are nonspecific and diagnostic clues arise from unanticipated imaging findings. Herein, we present a case of emphysematous cystitis in the setting of immunosuppressive medication. CASE PRESENTATION: Patient is a 69 year old female with a history of rheumatoid arthritis( on hydroxychloroquine, leflunomide and chronic prednisone) and diabetes who presented to the ICU with multiple episodes of abdominal pain, found to be in septic shock requiring aggressive hydration, vasopressors and mechanical ventilation. Imaging of the abdomen showed emphysematous cystitis with labs significant for leukopenia. Remaining blood work and imagining were benign. Patient was treated with broad spectrum antibiotics and foley catheter for bladder decompression. During hospital course, patient symptomatically improved and was able to be discharged on oral antibiotics to complete 14 day course. DISCUSSION: Emphysematous cystitis is a rare entity characterized by pockets of gas in and around the bladder wall produced by bacterial or fungal fermentation. Presentations can vary, from an incidental diagnosis in asymptomatic patients on imaging to severe sepsis. The prevalence of this disease is unknown however patients with severe diabetes, obstructive uropathy, immunodeficiency, recurrent UTIs are at high risk. About 2/3rd of infections are caused by E. coli while the remaining 1/3rd are caused by Enterobacter, Clostridium, Klebsiella species. CT is required for a definitive diagnosis. Most patients can be treated successfully with antibiotics, bladder drainage and treatment of the predisposing condition. IV antibiotics such as fluoroquinolones and beta-lactams are appropriate in these cases. In our case, patient was started on cefepime and metronidazole which was transitioned to trimethoprim-sulfamethoxazole on discharge. A review of 135 reported cases found that 10% required surgical intervention, typically for necrotizing infection or failure of conservative therapy. The overall mortality rate is up to 10% for this condition. Delay in diagnosis could lead to septicemia, peritonitis and bladder rupture. CONCLUSIONS: Although emphysematous cystitis is potentially life threatening, early medical management can contribute to achieving a favorable prognosis without need for surgical intervention. In susceptible populations, prompt recognition and treatment is required. REFERENCE #1: Fumeo M, Manfredi S, Volta A. Emphysematous cystitis: review of current literature, diagnosis and management challenges. Vet Med (Auckl). 2019;10:77-83 DISCLOSURES: No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response