Refractory Urinary Tract Infection Research Articles

Safety and efficacy of thermo-expandable metallic stent in ureteral stricture following gynecological malignancy surgery and radiotherapy: a single center experience with 33 cases.

The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors. In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed. The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant. Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors.

Children and adolescents with severe motor and intellectual disabilities who underwent kidney transplantation.

Kidney transplantation (KT) in children and adolescents with severe motor and intellectual disabilities (SMID) has been a topic of controversy. A multicenter study in Japan showed that KT was not contraindicated for children with multiple handicaps, but no consensus has been reached on KT for patients with SMID. This study aimed to determine whether KT is a viable treatment option for children and adolescents with SMID. A single-center, retrospective study was conducted on children and adolescents with SMID who underwent KT. SMID was defined based on Oshima's classification. Clinical information was collected through a review of medical records. Of 453 children and adolescents who underwent KT between 1983 and 2023 in our institution, six (1.3%) patients with SMID were identified. One patient received KT twice. All patients underwent living KT. Five patients used medical devices, including gastrostomy and a ventriculoperitoneal shunt, prior to KT. Perioperative complications, including hemothorax related to central venous catheter insertion, ventilator-associated pneumonia, and common iliac artery thrombosis requiring graftectomy, occurred in three patients. One patient required vesicostomy owing to refractory urinary tract infection. There was no significant difference in the graft survival rate between patients with SMID and those without SMID. One patient developed graft failure and died after selecting conservative kidney management. Our study showed a favorable graft survival in children and adolescents with SMID who underwent KT. Although careful perioperative management and continued medical care are required, KT may be a viable option for these patients.

Genetic and enzymatic characterization of two novel blaNDM-36, -37 variants in Escherichia coli strains

The widespread of different NDM variants in clinical Enterobacterales isolates poses a serious public health concern, which requires continuous monitoring. In this study, three E. coli strains carrying two novel blaNDM variants of blaNDM-36, -37 were identified from a patient with refractory urinary tract infection (UTI) in China. We conducted antimicrobial susceptibility testing (AST), enzyme kinetics analysis, conjugation experiment, whole-genome sequencing (WGS), and bioinformatics analysis to characterize the blaNDM-36, -37 enzymes and their carrying strains. The blaNDM-36, -37 harboring E. coli isolates belonged to ST227, O9:H10 serotype and exhibited intermediate or resistance to all β-lactams tested except aztreonam and aztreonam/avibactam. The genes of blaNDM-36, -37 were located on a conjugative IncHI2-type plasmid. NDM-37 differed from NDM-5 by a single amino acid substitution (His261Tyr). NDM-36 differed from NDM-37 by an additional missense mutation (Ala233Val). NDM-36 had increased hydrolytic activity toward ampicillin and cefotaxime relative to NDM-37 and NDM-5, while NDM-37 and NDM-36 had lower catalytic activity toward imipenem but higher activity against meropenem in comparison to NDM-5. This is the first report of co-occurrence of two novel blaNDM variants in E. coli isolated from the same patient. The work provides insights into the enzymatic function and demonstrates the ongoing evolution of NDM enzymes.

Hidden in plain sight: urinary Cryptococcus neoformans missed by routine diagnostics in a patient with acute leukemia

Cryptococcuria is a rare manifestation of localized cryptococcal disease. We present a case of Cryptococcus neoformans urinary tract infection in an immunocompromised host missed by routine laboratory workup. The patient had negative blood cultures, a negative serum cryptococcal antigen (CrAg), and “non-Candida yeast” growing in urine culture that was initially dismissed as non-pathogenic. The diagnosis was ultimately made by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) from a repeat urine culture after transfer to a tertiary care center. Cryptococcus should be considered in the differential of refractory urinary tract infections growing non-Candida yeast.

Are Intravesical Aminoglycosides the New Gold Standard in the Management of Refractory Urinary Tract Infection: A Systematic Review of Literature.

Background: Antibiotic resistance in urinary pathogens is increasingly common, leading to rising cases of complicated urinary tract infections. Conventional antimicrobial treatment may be insufficient in these cases and broad-spectrum systemic antibiotics contribute to the problem. Intravesical aminoglycoside instillation is an alternative treatment option that delivers localized and high-dose treatment to the source of infection. This study summarizes the existing evidence for the efficacy and safety of this treatment. Methods: A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the prevention and reduction in urinary tract infections, eradication of antimicrobial-resistant organisms, or change in sensitivities allowing conventional oral antimicrobial treatment after the administration of intravesical aminoglycoside with or without polymyxin therapy. Results: The search identified 826 articles, of which, 19 were included in the final data analysis and narrative synthesis. A successful outcome was identified in 80.7% (n = 289) of patients treated with aminoglycoside alone and 79.5% (n = 163) treated with an aminoglycoside in combination with polymyxin. Discontinuation was noted in 6.2% of patients. An increase in antimicrobial sensitivity was seen in 15.3% (n = 55) and 16.3% (n = 36) in the aminoglycoside and aminoglycoside/polymyxin groups, respectively. Conclusions: Current evidence supports the use of intravesical aminoglycoside instillation as an efficacious and safe treatment for refractory UTIs. Nevertheless, data is limited, and larger volume studies with longer follow-up periods are required.

Renal Mucormycosis in a Healthy Boy for Ten Years: A Novel Case Report

: Mucormycosis is rare in urinary tract infections. Renal mucormycosis is considered in immunocompromised patients and is associated with a high mortality rate. Herein, we presented the first case of a non-invasive fungus ball caused by a Rhizopus species confined to the unilateral kidney in a healthy boy for approximately ten years. The etiology was identified using next-generation deoxyribonucleic acid (DNA) sequencing. The patient recovered completely after nephrectomy without bladder irrigation. Therefore, clinicians must have a high index of suspicion for fungal infections in refractory urinary tract infections. Next-generation DNA sequencing technology can be used for an accurate diagnosis.

Ureteral Stent Placement as a Treatment Option of Ureteral Stenosis in Comorbid Patients: A Single-Center Experience

Background: Ureteral stenosis consist a medical condition characterized by high percentage of morbidity index causing refractory urinary tract infections, lithiasis as well as renal impairment and as a result, it is associated with poor outcomes regarding patients’ quality of life. Cold-knife, electrocautery, laser incision as well as surgical reconstruction are different options of treatment. However, in comorbid patients unfit for surgery permanent ureteral stent placement should be an alternative approach. Aims and Objectives: Assessing success rate and safety profile of ureteral stenting in comorbid patients with ureteral stenosis. Materials and Methods: In this retrospective study data was collected from patients underwent ureteral stent placement in our department. Personal history, laboratory examination and frailty assessment was documented in each case. Meanwhile, complications and success rate of the procedurewere recorded. Conclusion: Ureteral stent placement consist a safe treatment approach in patients with ureteral stenosis and many comorbidities. However, urologists should inform patients about the risk of stent withdrawal.

A case in which a near-infrared ray catheter (NIRC) was effectively applied in laparoscopic sigmoidectomy for a sigmoidovesical fistula.

A 40-year-old man visited the hospital for a refractory urinary tract infection. A sigmoidovesical fistula resulting from a sigmoidovesical diverticulum was diagnosed, and laparoscopic surgery was performed. To avoid ureteral injury during surgery for highly advanced cancer and inflammatory diseases, a ureteral stent is generally placed before the procedure. However, in this case, surgery was performed using a near-infrared ray catheter (NIRC), which emits fluorescence when irradiated with near-infrared light. By clearly observing the pathway of the ureter via near-infrared light, the integrity of the ureter could be preserved, and sigmoidectomy was safely performed. The visual navigation of the ureter with NIRC was especially useful during surgery for a colovesical fistula with marked surrounding inflammatory changes and a high risk of ureteral damage.

Analysis of 3 Cases of Refractory Urinary Tract Infection Caused by Enterococcus Faecium and Literature Review

Objective: To explore the clinical features, drug resistance, treatment and prognosis of refractory urinary tract infection caused by Enterococcus faecium infection. Methods: A retrospective analysis of 3 cases of Enterococcus faecium infection admitted to the Children’s Hospital of Shaanxi Provincial People’s Hospital from January 2017 to December 2019, And the clinical manifestations of refractory urinary tract infections caused by it, routine laboratory examinations, mid-stage urine culture and drug sensitivity, urinary ultrasound, magnetic resonance (or CT) examination, treatment process and prognosis, and search and review relevant literature. Result: The three children in this group were all women, aged 5 years, 2 months, 9 years and 11 years old. One case had renal abscess, one case had acute pyelonephritis, and one case had bladder-ureteritis. Clinical features: 2 cases had fever with a temperature of 38-39.5°C, and children with renal abscess were accompanied by chills; 2 cases had frequent urination, dysuria, and urethral irritation; 1 case of 5-year-old child had only transient urinary retention, All 3 cases were treated with conventional antibiotics orally and intravenously outside the hospital. During the course of 2 cases, the leukocytes were more than 25×109/L, 3 cases had neutrophils above 70%, CRP was high, and 3 cases of mid-stage urine culture were Enterococcus faecium;2 cases were sensitive to vancomycin and linezolid, Others are resistant.3 cases had negative blood cultures, 1 case of urinary B-mode ultrasound had a thicker bladder wall, and a slightly thicker wall in the lower right ureter. Considering the inflammatory changes, 1 case had left hydronephrosis and 1 case had left kidney urinary salt crystals. MRI plain scan of both kidneys and ureters + MRU showed: 1 case had a thicker bladder wall, and the wall of the lower ureter was slightly thickened, considering the inflammatory changes. One case had a slight dilation of the upper left ureter and the renal pelvis and calyces. 1 case of CT enhanced scan + CTU showed: 1. Left nodular superior nodules and strip low-density shadow, considering the repeated deformity of the left renal pelvis and ureter with dilation of the ureter (upper renal pelvis is small, hypoplasia); [2]. Abnormal strengthening of the left kidney and a slight thickening of the fascia around the kidney; consider pyelonephritis with abscess formation or cystic lesions. 3. Mild water accumulation in the left kidney and upper middle ureter [4]. There are multiple lymph nodes in the retro peritoneum and the left side of the spine, and some are swollen. Treatment 3 cases were initially ineffective with three generations of cephalosporins, and 2 cases had obvious effect of intravenous infusion of vancomycin based on drug sensitivity. After 7-10 days of treatment, cefepime was changed for consolidation treatment and cured. One case of meropenem treatment improved. Three cases were followed up for 1 year without recurrence. 1 case relapsed 20 days after discharge, intravenous infusion of cefepime for 17 days, and nitrofurantoin was taken preventively for 2 weeks before relapse. Conclusion: Most of the urinary tract infections caused by Enterococcus faecium infections are refractory upper urinary tract infections, which have many complications, timely and mid-stage urine culture, and urinary tract B ultrasound. Magnetic resonance imaging and hydrography of both kidneys and ureters play an important role in the diagnosis of complications. High drug resistance, timely adjustment of treatment according to drug susceptibility, selection of effective drugs is very important, given a sufficient course of treatment, can improve the prognosis.

Effective remission of an elderly patient with refractory atopic dermatitis and foot ulcers following infusion with human umbilical cord‑derived mesenchymal stem cells: A case report

Mesenchymal stem cells (MSCs) are excellent sources for use in the treatment of refractory and relapsing disorders mainly due to their hematopoietic‑supporting and immunoregulatory capacities. However, their safety and effectiveness for the treatment of refractory atopic dermatitis (AD) and multiple complications in elder patients are largely unknown. Therewith, the present study describes the case of a 65‑year‑old female patient with AD accompanied by foot ulcers and refractory urinary tract infection. Briefly, 5x10⁷ human umbilical cord‑derived MSCs (hUC‑MSCs) were intravenously infused into the body of the patient after obtaining the approval of the relevant ethics committee and the consent of the patient. The clinical and biochemical outcomes, including general symptoms, hemogram and blood constituents, medical images, together with tumour biomarkers, were observed and recorded. By conducting only one single intravenous infusion of hUC‑MSCs, the AD‑associated pathophysiological manifestations of the elderly patient, including an unbearable itch, diffuse erythema and eczema, and in particular, inflammatory foot ulcers and refractory urinary infection were completely attenuated. Simultaneously, the outcomes of the accompanied complications were effectively improved, whereas no recrudesce or adverse reactions were observed in the 14‑month follow‑up visit. The findings of the present study suggested that the administration of hUC‑MSCs was safe and effective for restricting the symptoms and of the patient preventing associated complications. Thus, the use of hUC‑MSCs may prove to be a promising treatment option for AD and foot ulcer management, even for elderly patients with multiple underlying conditions or complications.

Determination of minimum biofilm eradication concentrations of orbifloxacin for canine bacterial uropathogens over different treatment periods.

Biofilm formation can cause refractory urinary tract infections (UTIs) in dogs; however, minimum biofilm eradication concentrations (MBECs) of veterinary drugs against canine uropathogens remain to be investigated. In this study, the MBECs of orbifloxacin (OBFX), trimethoprim-sulfamethoxazole (TMS) and amoxicillin/clavulanate (ACV) over different time periods for treatment of canine uropathogenic Escherichia coli (n = 10) were determined. The MBECs of OBFX for other bacterial uropathogens, including Staphylococcus pseudintermedius (n = 5), Pseudomonas aeruginosa (n = 5), Klebsiella pneumoniae (n = 5) and Proteus mirabilis (n = 5) were also determined. Minimum inhibitory concentrations (MICs) were identified for all strains by broth microdilution, and MBECs were determined at 24, 72, and 168 hr using the Calgary biofilm method. The 24 hr MBECs of OBFX, TMS and ACV for the E. coli strains were significantly higher than the MICs (P < 0.05), and the 72 and 168 hr MBECs were significantly lower than those at 24 hr (P < 0.05). In addition, the 24 hr OBFX MBECs for the four other uropathogens were significantly higher than the corresponding MICs (P < 0.05). The 72 and/or 168 hr OBFX MBECs for S. pseudintermedius, K. pneumoniae and P. mirabilis were significantly lower than the 24 hr concentrations (P < 0.05), whereas for P. aeruginosa, no significant difference was found between any of the MBECs (P > 0.05). These data indicate that the administration period and uropathogenic bacterial species are important factors affecting the efficacy of OBFX treatment of biofilm-related UTIs in dogs.

Refractory urinary tract infection in a male with colovesical fistula

A colovesical fistula is a communication between the lumen of the colon and the bladder, which sometimes results from diverticulitis. The left or sigmoid colon is the most commonly involved segment. The most usual presenting symptoms are pneumaturia and fecaluria, followed by dysuria, abdominal pain and, rarely, hematuria; these patients also often present with symptoms of recurrent/chronic urinary tract infection. Â We present here the case of a 57-year-old man complaining of recurrent lower urinary tract symptoms followed by pneumaturia and fecaluria. Computed tomography of the abdomen and pelvis revealed a colovesical fistula due to sigmoid diverticulitis. After locating the fistula, the lesion was totally removed, including the segmental sigmoid colon and partial bladder. The anastomosis was completed with a circular stapler and the bladder defect wall was repaired with double suture. The patient was doing well 3 months post-operatively and showed no evidence of urinary tract infection. Patients with repeated and refractory urinary tract infections should be considered for anatomical disorders such as colovesical fistula.

Inguinoscrotal herniation of bladder: case series and literature review

Bladder hernias are relatively rare condition while only accounts for 1–4 % of inguinal hernias. It is not the surgery but the diagnosis that remain the major challenges of clinical practice. Herein, we report five cases of bladder hernias with different clinical presentation, and review of current literature. The definite diagnosis relies on clinical suspicion and multiple urographic imaging. Sonography is a preferred image modality for its inexpensive and noninvasive nature. Abdominal computed tomography (CT) could depict the anatomic details of the hernia lesion and its relationship with the surrounding pelvic organs. Although bladder herniation is not a malignant condition, it can be fatal due to iatrogenic surgical complications. In addition to current indications, refractory urinary tract infection should be viewed as another indication of partial cystectomy. Besides, repeated urography should be considered as the tool to ensure the result of surgery.

Granulomatous tubulointerstitial nephritis in a renal allograft: three cases report and review of literature

Granulomatous interstitial nephritis (GIN) is a rare histologic diagnosis in renal allografts. We report three cases with GIN. Case 1: a 37-yr-old woman received a kidney from her mother. On follow-up 15 months later, serum creatinine was increased and a graft biopsy showed epithelioid granuloma in the center of massive mononuclear cell infiltration. She had presented with refractory urinary tract infection treated with antibiotics before biopsy. The case was presumed to be GIN associated with UTI or hypersensitivity to medication. Case 2: a 47-yr-old woman received a second graft from a non-heart-beating donor. A protocol graft biopsy was performed six months after transplantation and showed several granulomatous nodules. She was followed closely without therapy. Case 3: a 27-yr-old woman received an ABO-incompatible kidney from her father. A protocol graft biopsy was performed three months after transplantation and showed granulomatous reaction with severe mononuclear cell infiltration. She received steroid pulse therapy. The two latter patients had no obvious factor contributing to GIN. Therefore, they were presumed to have idiopathic GIN. Infection is considered to be the main causative factor of GIN in renal allografts. This paper describes rare cases of GIN that had no infectious episode in the renal allografts.

Urolithiasis and cystotomy in the rabbit

Cystotomy is a surgical incision into the urinary bladder, which may be required for removal of calculi, diagnosis of tumors or refractory urinary tract infections, or repair of ectopic ureters and ruptured bladders. This column describes the indications and techniques for cystotomy in the rabbit.

Combined antibiotic therapy in refractory urinary tract infections.

Comprehensive in vitro studies by one of us (G. M. E.) 1 on the inhibition of various bacteria by antibiotic combinations indicated that a combination of aureomycin, oxytetracycline (Terramycin), and chloramphenicol possessed antibacterial properties that were not evident when these antibiotics were tested singly in equal concentrations against the same organisms. The present study, part of a more extensive project to be reported later, was undertaken to test this combination clinically. In this report, major emphasis will be placed on our experiences in the treatment of selected patients with refractory urinary tract infections. In addition, attention will be directed to the significance of certain factors, which became manifest only after the study had progressed for a time and which we now believe are fundamental to proper clinical evaluation of any antibacterial agent intended for use in this type of infection. MATERIALS AND METHODS The antibiotic combination, hereafter referred to as