Pyelonephritis Research Articles

Molecular analysis of acute pyelonephritis—excessive innate and attenuated adaptive immunity

This study investigated the molecular basis of disease severity in acute pyelonephritis (APN), a common and potentially life-threatening bacterial infection. Two cohorts of infants with febrile urinary tract infection were included. Renal involvement was defined by DMSA scans and molecular disease determinants by gene expression analysis and proteomic screens, at diagnosis and after 6 mo. Innate immune hyper-activation, systemically and locally in the urinary tract, was defined as a cytokine storm. Neutrophil degranulation and renal toxicity genes were strongly regulated, with overexpression in the APN group (first DMSA+). Adaptive immune attenuation in the APN group further supported the notion of an immune imbalance. DNA exome genotyping identified APN and febrile urinary tract infection as genetically distinct and scarring associated genes, but the activation of renal toxicity genes during acute infection was unrelated to the development of renal scarring. The results define APN as a hyper-inflammatory disorder with the characteristics of a cytokine storm combined with adaptive immune attenuation. The findings are consistent with innate immune dysfunctions and neutrophil disorders identified as determinants of APN susceptibility in genetic models.

Initial experience of a novel ureteral silicon-covered metallic mesh stent in malignant ureteric obstruction: a single-center retrospective study

BackgroundThis study aimed to investigate initial experiences and outcomes of a retrograde inserted new silicone-covered metallic ureteric stent (Urexel™) for malignant ureteric obstruction.MethodsWe retrospectively reviewed the medical records for 12 consecutive patients who underwent Urexel™ stent placement for malignant ureteric obstruction from March 2020 to March 2021. The Urexel™ stent is a segmental metallic ureteric stent composed of a nitinol mesh covered with a silicone membrane. We evaluated the clinical outcomes and complications of this new metallic ureteric stent.ResultsThe median age of patients was 61.5 (44–82) years, and the median follow-up was 25.5 (4–37) months. One of the 12 patients underwent bilateral stent insertion, Urexel™ stents were placed in a total of 13 ureteral units. There was no technical failure during stent placement. The median length of obstructions was 9 (1–22) cm. Balloon dilation was necessary in 38.5% (5/13 ureter units) of cases. The 6-month success rate was 83.3%, 1-year success rate was 70%, and estimated success rate was 44.4% at 2-year. Encrustation, migration and hyperplasia were the cause of overall treatment failure in all 6 cases of failure, with median elapsed time to failure of 9.5 (1–30) months. Common complications included persistent pain, acute pyelonephritis, and lower urinary tract symptoms, but they were Clavien-Dindo grade I or II.ConclusionsIn this initial series of novel ureteral silicon-covered metallic mesh stents, Urexel™ provided acceptable success and complication rate in malignant ureteric obstructions.

Chronic Kidney Disease and Infection Risk: A Lower Incidence of Peritonsillar Abscesses in Specific CKD Subgroups in a 16-Year Korean Nationwide Cohort Study.

Peritonsillar abscesses and deep neck infection are potentially serious infections among patients with chronic kidney disease (CKD), posing risks for severe complications and drawing significant public health concern. This nationwide, population-based longitudinal study (2002-2019) assessed the extended relationship between chronic kidney disease (CKD) and the likelihood of peritonsillar abscess and deep neck infection in a Korean cohort. Using a 1:4 propensity score overlap-weighted matching, we included 16,879 individuals with CKD and 67,516 comparable controls, accounting for demographic variables and comorbidities to ensure balanced group comparisons. Hazard ratios (HRs) and 95% confidence intervals (CIs) for deep neck infection and peritonsillar abscesses in relation to CKD history were calculated with a propensity score overlap-weighted Cox proportional hazards model. Our results revealed no significant increase in the overall incidence of deep neck infections or peritonsillar abscesses in CKD patients compared to controls. Interestingly, CKD patients demonstrated a 50% reduced likelihood of developing peritonsillar abscesses (HR 0.50; 95% CI = 0.30-0.83; p = 0.007), particularly among subgroups aged 70 years or older, females, non-smokers, rural residents, overweight individuals, and those with lower comorbidity burdens (e.g., absence of hypertension, hyperlipidemia, or hyperglycemia). In summary, the results suggest that lifestyle modifications and the effective management of comorbidities could reduce the risk of peritonsillar abscess in certain CKD subgroups. Our findings may help to alleviate public health concerns regarding peritonsillar abscesses and deep neck infections as CKD-related comorbidities.

QSPR Analysis of Kidney Infection (Pyelonephritis) Drugs by Entropy Graphs Weighted with Topological Indices, and MATLAB Programming

The entropy of the chemical graph primarily measures the complexity of chemical structures. In this study, Shannon’s entropy approach was utilized to calculate entropies for chemical graphs with degree-based topological indices, predicting the physicochemical correlation capability of 12 drugs for kidney infection and its implications for physicochemical aspects. Entropy can help identify important correlations between the structure and function of compounds, which in turn can aid in developing QSPR models. A computer-based computing technique and algorithm were employed to simplify calculations and data analysis. Degree-based topological indices, along with the entropy graphs weighted with indices, were calculated using the MATLAB program and used to measure entropy. This research aims to predict the physicochemical characteristics of these drugs based on the entropy of topological indices. Several regression models were used to analyze drugs’ quantitative structure-property relationship (QSPR) and predict their physicochemical properties. Effective predictors were identified in this study, and optimal equations were introduced to evaluate the physicochemical characteristics based on the highest correlation coefficient and Fisher’s statistical test. Interestingly, in some cases, the entropy of degree-based indices showed a stronger correlation with drug characteristics. In conclusion, the optimal equations for estimating molar refractivity (MR) and polarizability (P) using the ENT RR − 1 / 2 , ENT SC , and ENT ABC indices incorporate compound, growth, and exponential factors. Meanwhile, the optimal equations for estimating molar volume (MV) with the ENT F index are quadratic and cubic.

Treatment patterns and burden of uncomplicated urinary tract infection in England.

Uncomplicated urinary tract infections (uUTIs) are common bacterial infections. Evaluate the burden of uUTI in England for 1) potential determinants of disease progression; 2) extent and impact of antimicrobial prescribing non-concordant with treatment guidelines; and 3) economic burden and costs. Retrospective cohort study utilising patient data from the Clinical Practice Research Datalink (CPRD) linked to English Hospital Episodes Statistics. Female patients aged≥12 years with a new uUTI between 2018-2019,≥14 months' continuous CPRD enrolment (≥12 months baseline,≥2 months follow-up), and≥1 oral antibiotic prescription±5 days of uUTI diagnosis were included. Baseline characteristics were described in patients with/without disease progression (hospitalisation for acute pyelonephritis/bacteraemia/sepsis). Treatment non-concordance with current English guidelines was assessed. Burden (all-cause and UTI-related healthcare resource use [HCRU] and costs) was evaluated in a 1:1 age-/comorbidity-matched uUTI-free cohort. Of 120,519 patients, 207 (0.2%) had disease progression requiring hospitalisation (during index uUTI episode); determinants included older age, index home consultation, prior hospitalisation and medications prescribed for comorbid conditions in the prior 12 months (British National Formulary classes: cardiovascular, eye, other). Non-concordant treatment was observed in 43.5% of patients. All-cause HCRU burden and costs were significantly higher in patients with uUTI versus age-/comorbidity-matched controls (P<0.001) at 28 days (£160.06 versus £37.63) and in the 12-month follow-up (£1206.77 versus £460.97). All-cause HCRU burden and costs were significantly higher in uUTI patients versus matched controls (P<0.001). Hospitalisation for acute pyelonephritis, bacteraemia, or sepsis following uUTI was uncommon.

ГНОЙНЫЙ ЭПИДУРИТ: ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ В ПРАКТИКЕ ВРАЧА-ТЕРАПЕВТА

Relevance. Back and neck pain is one of the most common reasons of visiting a doctor. Pain syndrome is mostly related to lesion of the musculoskeletal system components, but may be due to specific reasons as traumas, systemic inflammatory diseases, tumors, etc. The reasons of spinal pain may be spinal infections which refer to quite rare and difficult to diagnose diseases. A doctor should be concerned of the spinal infection in order to suspect this abnormality and to send a patient for respective examination. Case descriptions. The article presents a case of purulent epiduritis in a patient with chronic urological pathology. Difficulties in diagnosis were related to non-specific clinical symptoms of the disease, missing sings of the infection process in the spine as shown by computed tomography, presence of infection site of other localization. The patient was hospitalized in the therapeutic department with the diagnosis: Diabetes mellitus type 2, newly diagnosed. Vertebrogenic cervicobrachialgia on the left, exacerbation. Benign prostatic hyperplasia. Acute urinary retention. Chronic obstructive pyelonephritis, exacerbation. Antibacterial therapy, insulin therapy, and symptomatic therapy were administered. Intoxication, neurological symptoms, laboratory activity were observed during the therapy. The patient underwent MRI examination which resulted to diagnosing epiduritis of cervical and thoracic spine. Antimicrobial therapy regimen was changed which resulted to regression of neurological symptoms, pain syndrome, positive laboratory dynamics was observed. The patient was discharged following completion of intravenous therapy with recommendations on further treatment on outpatient basis. Conclusion. This clinical observation demonstrates the difficulties in diagnosing purulent-inflammatory disease of the spine in a patient with chronic urological pathology undergoing treatment in the therapeutic department. Magnetic resonance examination was crucial in establishing the correct diagnosis. The conservative therapy with antimicrobial agents was effective in this case; no surgical treatment was required.

Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in "Acute Obstructive Uropathy": A Critical Evaluation.

Aim: To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. Patients and Methods: Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. Results: A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (p < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% vs 7.3%). Conclusions: Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.

Clinical Features and Outcomes of Patients With COVID-19 Infection and Acute Kidney Injury Requiring Hemodialysis in an Intensive Care Unit: A Retrospective Study From a Tertiary Care Center in Eastern India.

During the COVID-19 pandemic, it has been observed that acute kidney injury (AKI) especially requiring intervention support of hemodialysis has notably increased mortality rates among COVID-19-positive critically ill patients;however, comprehensive data regarding this from India, especially the eastern territory, remains sparse. This study aims to outline the demographic, clinical, and biochemical characteristics, along with the outcomes, of these patients. A retrospective study was performed at the All India Institute of Medical Sciences (AIIMS), Patna, from March 1, 2020, to March 31, 2021. Included were patients diagnosed with COVID-19 and AKI necessitating hemodialysis during their intensive care unit (ICU) stay. These patients tested positive for COVID-19 and met the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI stages 1-3, requiring ICU admission and hemodialysis. Medical history, clinical features, laboratory results, comorbidities, and demographic data were collected and analyzed. Patients were tracked from admission to discharge or death. Gaussian-distributed values were compared using the unpaired t-test or Pearson's test, while non-Gaussian continuous variables were analyzed using the Mann-Whitney test or Spearman's test. The study employed the Kolmogorov-Smirnov test to assess Gaussian distribution, while categorical data were compared using the Chi-square test. Among 773 patients with positive COVID-19 tests who were admitted to the ICU, 236 patients developed AKI, andamong them, 139 patients required hemodialysis. The total mortality rate was 167 (70.7%) among people who had AKI and 102(77%) in patients with AKI who required hemodialysis. AKI was also a risk factor associated with higher mortality rates in older patients (>45 years) (n=150 (73.2%)), those needing invasive ventilation (n=163 (88.1%)), and patients with elevated total leucocyte count (TLC) (n=130 (79.3%)), lactate dehydrogenase (LDH) (n=159 (72.9%)), interleukin-6 (IL-6) (n=153 (72.2%)), and serum ferritin (n=51 (73.7%)) and hypoalbuminemia (n=152 (73.1%)). AKI requiring hemodialysis significantly increases mortality risk in COVID-19 patients. Other risk factors for mortality with AKI in COVID-19-positive patients include age, elevated leucocyte count, invasive ventilation, and deranged inflammatory markers.

An insight into Pittaja Mutrakrichra w.s.r. to Lower Urinary Tract Infection with mechanism, risk factors &amp; prevention

In Ayurveda, diseases are named after taking into consideration of certain criteria which are very much significant. A disease named on the basis of Pravrutti of Mootra associated with difficulty in Pravrutti is Mutrakrichra i.e., passing urine with difficulty or pain. Eight types of Mutrakrichhra are described in details in Madhav Nidana - i.e., Vattaja, Pittaja, Kaphaja, Sannipataja, Shalyaja, Ashmarija, Shukraja, Purishaja Mutrakrichhra. Pittaja Mutrakrichhra was well acknowledged in Samhitas with different treatment modalities, which can be concurrent to Lower urinary tract infections on theoretical and clinical symptomatology of disease. Urinary Tract Infection (UTI) is defined as multiplication of organism in urinary tract.[1] Urinary tract infection is the inflammation of the tissues of the urinary tract.[2] Upper urinary tract infection is infection involving the kidney and lower urinary tract infection is infection involving the bladder, prostate, and urethra.[3] Hence in the present study, an attempt is made to critically analyze the disease Pittaja Mutrakrichra with its Nidana, Samprapti, Lakshana and with the disease Lower urinary tract infection. Lower urinary tract infection can be reduced by drinking plenty of fluids and completely emptying the bladder frequently. Menstrual hygiene changes sanitary pads or tampons regularly to maintain cleanliness and to prevent bacterial growth.

THE ROLE OF CYTOKINE PROFILE IN THE DEVELOPMENT OF ACUTE RENAL PATHOLOGY IN CHILDREN WITH COVID -19

Objective: This study aimed to investigate the impact of Covid-19 on the development of tubulointerstitial kidney damage in children, focusing on cytokine profiles, kidney function, and the role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker for kidney injury. Methods: A cohort of 132 children who experienced tubulointerstitial kidney damage post-Covid-19 was studied. The patients were divided into two groups: one with acute pyelonephritis (AP) and the other with acute tubulointerstitial nephritis (ATIN). Diagnostic methods included blood and urine analysis, renal ultrasound, cytokine profiling (IL-6, IL-4, TNF-α, γ-INF), and NGAL measurement. Results: The study found significantly elevated NGAL levels in the urine of children with AP and Covid-19 compared to healthy controls (110.74±1.27 vs. 65.66±0.64 ng/mg creatinine; p&lt;0.001). Cytokine analysis revealed substantial increases in IL-6, TNF-α, and γ-INF, particularly in children with Covid-19-related kidney damage, suggesting a severe inflammatory response contributing to kidney dysfunction. Novelty: This research highlights the crucial role of cytokines in kidney injury following Covid-19 in children and emphasizes NGAL as a reliable biomarker for early detection of renal damage, offering new insights for treatment and prognosis.

The Co-Infection of ISKNV-II and RGNNV Resulting in Mass Mortality of Juvenile Asian Seabass (Lates calcarifer), Zhuhai, Southern China.

Infectious spleen and kidney necrosis virus (ISKNV) and nervous necrosis virus (NNV) are two common and important causative agents in marine-cultured fish. However, high viral loads of both ISKNV and NNV in the same clinical case is unusual. In this study, a mass mortality event of Asian seabass Lates calcarifer juveniles occurred in Zhuhai, the main Asian seabass cultured area in mainland China. The fish samples were pooled for pathogen identification and both high viral loads of ISKNV and NNV were detected by real-time microfluidic quantitative PCR and conventional PCR. Immunohistochemistry and immunofluorescence showed that strong ISKNV signals were detected in spleen and liver, while strong NNV signals were detected in brain and eye. The tissue homogenates were inoculated into MFF-1 cell and SSN-1 cell, respectively. After several viral passages, both individual ISKNV and NNV were purely isolated from each other, and designated as ASB-ISKNV-23 and ASB-NNV-23, respectively. The whole genome sequences of ASB-ISKNV-23 and ASB-NNV-23 were determined and annotated. The result showed that ASB-ISKNV-23 and ASB-NNV-23 are composed of 112,236 bp and 4441 bp, respectively. Phylogeny analysis showed that ASB-ISKNV-23 belongs to ISKNV-II sub-genotype and ASB-NNV-23 belongs to RGNNV genotype. Collectedly, coinfection of ISKNV-II and RGNNV were firstly documented in mass mortality of Asian seabass in mainland China. Importantly, both individual ISKNV-II and RGNNV were purely isolated using two different permissive cell lines. Our study provides useful information for better understanding the complex pathogenesis regarding the coinfection with ISKNV and NNV in farmed fish.

ScTRIM44 Positively Regulated Siniperca Chuatsi Rhabdovirus Through RIG-I- and MDA5-Mediated Interferon Signaling.

Tripartite Motif-Containing 44 (TRIM44) is responsible for cancers, neurodegenerative diseases, and viral infections. However, the role of Siniperca chuatsi TRIM44 (scTRIM44) during viral infection remains unclear. In the present study, we analyzed the molecular characteristics of scTRIM44 and its role in infectious spleen and kidney necrosis virus (ISKNV), largemouth bass virus (LMBV), and Siniperca chuatsi rhabdovirus (SCRV) infection. ScTRIM44 contained one B-box domain (B, 166-207 aa) and a coiled-coil domain (CC, 279-309 aa), but lacked the canonical RING domain of E3 ubiquitin ligases. The scTRIM44 mRNA was expressed relatively high in immune-related tissues. The mRNA expression of scTRIM44 significantly decreased in vivo and vitro post-ISKNV and -LMBV infection. However, the expression of scTRIM44 mRNA showed significant up-regulation post-SCRV infection. ScTRIM44 positively regulated SCRV infection in CPB cells, but copies of ISKNV and LMBV showed no significant alteration in over-expressed or knocked-down scTRIM44 cells. Moreover, scTRIM44 positively regulated RIG-I- and MDA5-mediated interferon molecule signaling. These data suggested that scTRIM44 promoted SCRV infection by positively regulating RIG-I- and MDA5-mediated interferon molecule signaling, but didn't regulate ISKNV and LMBV infection. This research provided a comprehensive insight into the antiviral activity of scTRIM44.

Bacteriophage therapy and prevention of infectious and inflammatory complications after endoscopic urologic surgery

Relevance. Given the growing antibiotic resistance of pathogens of urologic infection to antimicrobial drugs, one of the urgent problems is the search for alternative methods of antimicrobial prevention of infectious and inflammatory complications after surgical interventions, as well as an adequate therapy regimen during the postoperative period. Bacteriophage preparation is an alternative method for the treatment and prevention of infectious and inflammatory urological diseases.Objective. To determine an effective method for preoperative antimicrobial prevention of infectious and inflammatory complications in patients with kidney stones subjected to percutaneous nephrolithotripsy (PNLT).Methods. The study included 90 patients with coralloid or multiple large kidney stones who underwent PNLT. Before PNLT, all patients underwent bacteriological urinalysis in order to determine sensitivity not only to antibiotics and bacteriophage preparations. Urine sampling was performed for further microbiological cultural examination during renal pelvic puncture on the 3rd and 7th days after PNLT. Depending on the technique of perioperative prophylaxis, three groups of 30 were formed. Group 1 patients were intravenously injected with 1000 mg of ciprofloxacin throughout the operation and then intravenously dipped with 1000 mg once a day for 3–5 days. Group 2 received intramuscular cefotaxime + sulbactam (1.0+0.5) twice a day 2 h before surgery intramuscularly once. In group 3, patients received oral mycobacteriophage 40 ml polyvalent purified orally 1 h before surgery and 40 ml orally 3 times a day for 3–5 days after surgery.Results. In all three groups, the development of infectious complications in patients was assessed: acute pyelonephritis, systemic inflammatory reaction syndrome (SERS) or urosepsis. No serious infectious or inflammatory complications were observed in any group during the early postoperative period. The development of CVD after PNLT was noted on the 1st–3rd postoperative day (in 26.6 %, 20 and 20 % of patients of the 1st, 2nd and 3rd groups, respectively). However, on the 4th–7th day after PNLT, normal blood parameters (leukocytes, rod-shaped neutrophils), temperature, and general well-being were noted.Conclusion. The same effectiveness of different antimicrobial regimens for preventing infectious and inflammatory complications after PNLT was similar. Bacteriophage preparations are effective and can prevent infectious and inflammatory complications following PNLT. The development of CVD after PNLT on the 1st–3rd day after surgery cannot be correlated only with the antimicrobial drugs used and the method of their administration (intravenously, intramuscularly and orally). Most likely, the development of CVD is associated with operational injury.

Исследование дисфункции нижних мочевыводящих путей у женщин с рассеянным склерозом

Multiple sclerosis (MS) is a chronic disorder of the central nervous system affecting primarily young women. Neurogenic lower urinary tract dysfunction (NLUTD) represents one of the disease manifestations creating the risk of infectious complications and kidney disease. Today, there is insufficient data on the urinary microflora composition obtained by advanced high-tech diagnosis methods. The study aimed to perform clinical assessment of NLUTD associated with MS and its impact on the quality of life (QOL), as well as to clarify the data on the urinary microflora composition. A total of 33 women with MS aged 36 [39.5; 30.5] years were assessed using the customized questionnaires for estimation of the NLUTD prevalence and severity, as well as for QOL evaluation. Qualitative determination and quantification of urinary opportunistic microflora (OM) were performed using the real-time polymerase chain reaction. A total of 19 (57.6%) women with MS had symptoms of NLUTD: symptoms of the storage (15 individuals, 45.5%) and emptying (16 individuals, 48.5%) phases. In almost half of women with MS, the complaints included abnormalities of both bladder functioning phases (12 individuals, 36.4%); moderate abnormalities prevailed (12 individuals, 34.6%). Women with MS and NLUTD were more disabled based on the EDSS score (3.5 [5.0; 3.0] points; p &lt; 0.001) and had longer disease duration (13 [20.0; 5.0] years; p &lt; 0.001). The QOL index of women with NLUTD showed dissatisfaction with bladder function. The study revealed bacteriuria in patients with MS and NLUTD. The data on the urinary microflora composition are provided: OM members (bacteria of the ESKAPE group) have been found in 8 samples obtained from women with MS and NLUTD. Bacteriuria was asymptomatic.

Clinical Outcomes of Acute Pyelonephritis in Type 2 Diabetes Mellitus.

Background Diabetes mellitus (DM) is a prevalent predisposing factor for urinary tract infections (UTIs). Among hospitalized patients with acute pyelonephritis, UTIs are more common, severe, and associated with worse outcomes, particularly in those with type 2 DM. Pyelonephritis in DM patients is more frequently bilateral and linked to greater complications, with 90% of emphysematous pyelonephritis (EMPN) and cystitis cases occurring in diabetic individuals. Objective This study aims to evaluate the clinical and microbiological profiles, treatment outcomes, and complications of acute pyelonephritis in patients with type 2 DM. Methods A six-month prospective observational study was conducted from March 2016 to August 2016 at Stanley Medical College and Hospital, Chennai, India. A total of 102 hospitalized patients presenting with symptoms suggestive of acute pyelonephritis were included. Data were collected using a clinical questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Patients received culture-sensitive antimicrobial therapy, percutaneous drainage, and renal replacement therapy as required. Results Out of 102 patients, 80 (78.4%) had non-emphysematous pyelonephritis (NEMPN), and 22 (21.6%) had EMPN. The mean age was 55.2±10.9 years, with a female predominance of 63 (78.4%) participants. Escherichia coli was the most common organism isolated in 70 (68.6%) cases. Renal dysfunction was present in 67 (65.7%) patients, with a higher prevalence in EMPN (22, 100%) compared to NEMPN (45, 56.3%) (p<0.001). Mortality was observed in three (3.9%) patients, and 25 (24.5%) developed de novo or progressive chronic kidney disease. Conclusion Early diagnosis and aggressive management of EMPN in type 2 DM patients improve outcomes. Acute pyelonephritis is predominantly observed in women, with fever and loin pain as the most common symptoms. Escherichia coli is the primary pathogen, and renal dysfunction is frequent but often reversible. Mortality is low with appropriate management.

Cross-Validatory Z-Residual for Diagnosing Shared Frailty Models

Accurate model performance assessment in survival analysis is imperative for robust predictions and informed decision-making. Traditional residual diagnostic tools like martingale and deviance residuals lack a well-characterized reference distribution for censored regression, making numerical statistical tests based on these residuals challenging. Recently, the introduction of Z-residuals for diagnosing survival models addresses this limitation. However, concerns arise from conventional methods that use the entire dataset for both model parameter estimation and residual assessment, which may cause optimistic biases. This article introduces cross-validatory Z-residuals as an innovative approach to address these limitations. Employing a cross-validation (CV) framework, the method systematically partitions the dataset into training and testing sets to reduce the optimistic bias. Our simulation studies demonstrate that, for goodness-of-fit tests and outlier detection, cross-validatory Z-residuals are significantly more powerful (e.g., power increased from 0.2 to 0.6). and more discriminative (e.g., AUC increased from 0.58 to 0.85) than Z-residuals without CV. We also compare the performance of Z-residuals with and without CV in identifying outliers in a real application that models the recurrence time of kidney infection patients. Our findings suggest that cross-validatory Z-residuals can identify outliers, which Z-residuals without CV fail to identify. The CV Z-residual is a more powerful tool than the No-CV Z-residual for checking survival models, particularly in goodness-of-fit tests and outlier detection. We have published a generic function, which is collected in an R package called Zresidual, for computing CV Z-residual for the output of the widely used survival R package.

Assessment of co-resistance to antibiotics recommended for acute pyelonephritis among Escherichia coli clinical strains from community- and nursing home-acquired urinary tract infections.

This study aimed to assess the frequency of co-resistance to antibiotics recommended in acute pyelonephritis among Escherichia coli clinical strains isolated from urinary tract infections (UTIs) acquired in community or nursing homes (NHs), and to identify situations without alternatives to fluoroquinolones (FQs). All antimicrobial susceptibility test (AST) results of E. coli culture-positive urine samples from females living in the community or in NHs, collected through a large network of clinical laboratories in 2020 in France, were included. The percentages of strains resistant to amoxicillin alone or combined with a resistance to one to four alternatives among amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, cefixime and FQs were calculated and compared between age categories and settings. Among 291 367 E. coli strains from community-acquired UTIs, 60.3% were susceptible to amoxicillin (<65-year-olds: 61.8% versus ≥65-year-olds: 58.8%; P < 0.001), and 99.1% to oral alternatives to FQs. Co-resistance to amoxicillin and trimethoprim/sulfamethoxazole was higher among females ≥65 years old versus <65 years old (7.1% versus 6.1%; P < 0.01), as well as co-resistance to amoxicillin, amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole (8.6% versus 10%; P < 0.001). Among 11 340 strains from NH UTIs, 51.2% were susceptible to amoxicillin, and 98% to oral alternatives to FQs. Co-resistance to amoxicillin, amoxicillin/clavulanic acid and/or cefixime was higher in isolates from females ≥65 years old living in NHs versus in the community (respectively 11.9% versus 15.3%, P < 0.001; 0.8% versus 2.8%, P < 0.01; 1.7% versus 4.4%, P < 0.01). Based on AST results, prescribing oral alternatives to FQs for females may be possible in ≥99% of E. coli acute pyelonephritis cases in the community, and ≥98% in NHs.

Management of early ureteral injury complications

Introduction. Ureteral traumas account for approximately 3% of all urinary tract injuries. Up to 38 – 80 % of ureteral injuries are misdiagnosed. Consequently, missed ureteral injuries lead to the development of complications.Objective. To determine the comprehensive management for early complications of ureteral injuries.Materials &amp; methods. From 2000 to 2022, 46 patients with early complications of various mechanisms, types, and severity of ureteral injuries were treated at the Dzhanelidze Research Institute of Emergency Medicine. The severity of ureteral injury complications was determined using the Clavien-Dindo classification system. Reconstructive and staged operations were performed in the treatment of ureteral injury complications.Results. Fourty-three patients (93.5%) had iatrogenic injuries, 2 (33.3%) had blunt traumas, and 1 (2.2%) had an open injury. Ureteral injuries included rupture, ligation, endoclips compression, and thermal injury. The type of ureteral trauma determined the development of early complications. Ureteral ligation and endoclips compression led to the development of acute renal colic, hydronephrosis, and obstructive pyelonephritis. Ureteral rupture and thermal injury were complicated by urinary leaks and peritonitis. According to the Clavien-Dindo classification, the complications were IIIb and IV grade. Staged procedures were performed for the treatment of ureteral injuries complications in the presence of infection. In other cases, reconstructive operations were performed on hemodynamically stable patients with ureteral injury complications.Conclusion. The choice of management for early complications of ureteral injuries depends on the patient's condition, the presence of infection, the mechanism, type, and localisation of the ureteral trauma.

Association between hyponatremia and disease severity in pediatric urinary tract infections

BackgroundAcute urinary tract infection (UTI) is a common disease in pediatrics, with around 8% of girls and 2% of boys experiencing a UTI by age 7y/o. UTIs can range from asymptomatic bacteriuria to acute pyelonephritis (APN) in severe cases involving renal parenchymal infection. UTI patients admitted to the pediatric ward usually have more severe clinical presentation, compared to those treated in the outpatient settings. Therefore, it will be helpful to have markers that predict the severity of the disease and the likelihood of having APN.MethodsWe performed a retrospective review on all pediatric UTI/APN patients treated in the inpatient setting at a Medical Center from October 2012 to September 2022. Patients were assigned to the “hyponatremia” or “eunatremia” group according to their serum sodium concentrations. Detailed information, including renal echo, blood, and urine test results, were collected for the analysis of multivariable logistic regression model.ResultsThe study included 344 patients, of which 99 (28.8%) had hyponatremia, and 245 (71.2%) had normal serum sodium levels. The hyponatremia group had higher APN frequency, renal echo abnormality, and higher CRP level. In multivariable analysis, hyponatremia was independently associated with increased serum glucose (OR: 1.01, 95% CI: 1.00-1.03, p = 0.0365) and CRP levels (OR: 1.00, 95% CI: 1.00-1.01, p = 0.0417), without a significant increase in APN frequency as the final diagnosis.ConclusionsOur findings suggest that hyponatremia in pediatric UTI patients may indicate a more severe disease, such as APNs, higher CRP levels, or renal echo abnormalities. The complex mechanisms underlying hyponatremia and its predictive value for disease severity warrant further investigation.

Deceased Donor Infectious Diseases Testing and Antimicrobial Use: Surveys of Organ Procurement Organizations and Transplant Professionals.

Donor screening and antimicrobial management processes are inconsistent across organ procurement organizations (OPOs) and transplant centers. As part of a Controversies Conference addressing the evaluation and management of infectious diseases (ID) in deceased donors sponsored by the American Society of Transplantation (AST), two online pre-meeting surveys were developed to inform conference proceedings and assess current practices and opinions on donor screening and antimicrobial management. Survey 1 addressed the current state of deceased donor ID testing, culture data communication, antimicrobial utilization, and involvement of transplant ID during donor management and was distributed to all 56 United States OPOs. Survey 2 evaluated transplant professionals' opinions regarding donor antimicrobial use and was sent to the AST Infectious Disease, Kidney Pancreas, Liver and Intestinal, and Thoracic and Critical Care Community of Practice listservs. Descriptive statistics were performed. Thirty-five (63%) unique responses were received from OPOs for Survey 1. Findings included variability in the timing of donor culture collection, frequent sampling of indwelling catheters, wide variation in the location of culture processing, and availability of additional susceptibility testing. Eighty-eight unique responses were received from approximately 1552 (6%) transplant providers for Survey 2. Of the respondents, 37% would not recommend standard antibiotics prior to organ recovery in the absence of suspected or confirmed infection. These surveys demonstrate variability in donor testing, donor antimicrobial utilization, and transplant provider opinions regarding the need for and selection of antimicrobial agents. Findings highlight opportunities for standardized approaches to donor testing and management.