China
Africa
Explore chapters and articles related to this topic
Urology
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
These are similar to rigid cystoscopy. Any active urinary tract infection should preclude a cystoscopy until it is cleared. This is to avoid the risk of a urosepsis. It is common to perform a urinalysis +/– urine culture a few days before a scheduled cystoscopy. Whether prophylactic antibiotics is needed remains controversial and is beyond the scope of this book, although a recent Cochrane review found no strong evidence for its use (Zeng et al., Cochrane review, 2019).
Endotoxin, Antibiotics, and Inflammation in Gram-Negative Infections
Published in Helmut Brade, Steven M. Opal, Stefanie N. Vogel, David C. Morrison, Endotoxin in Health and Disease, 2020
Should the endotoxin-liberating potential of a given antibiotic be a major determinant in the choice of the antibiotic in case of a serious gram-negative infection? It is clear that the clinical studies discussed do not justify that conclusion. In the mentioned comparative study in patients with urosepsis, all patients treated had a favorable outcome. However, urosepsis is a relatively mild form of sepsis, and therefore recovery was expected in all patients provided that an adequate antibiotic treatment was given. It is conceivable that in more severe forms of septic shock, any additional endotoxin release and/or cytokine production following antibiotic treatment might influence survival.
Nosocomial Pneumonia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
There are many causes of new or persistent fever/leukocytosis in the CCU. The most common causes for persistent fever/leukocytosis in the CCU are stress of being in the CCU, hemorrhage, steroids, or drug fever. Non-pulmonary infection /non-infectious disorders should also be considered, e.g., phlebitis, DVT, PE, MI, and pancreatitis (drug or TPN induced). Causes are virtually never urosepsis (without recent urologic instrumentation), even with or without pyuria/bacteriuria. C. difficile diarrhea may cause mild leukocytosis without fevers. In contrast, C. difficile colitis presents with new high fevers (>102°F) and prominent abdominal pain, often with sudden cessation if antecedent C. difficile water diarrhea. In all these scenarios, selecting appropriate therapy depends on accurate clinical syndromic diagnosis. The approach to persistent fever/leukocytosis should be directed at determining the cause, rather than adding or changing antibiotics [2,7,8].
Emergency decompression for patients with ureteral stones and SIRS: a prospective randomized clinical study
Published in Annals of Medicine, 2023
Xiaofei Lu, Benzheng Zhou, Dechao Hu, Yanting Ding
There are many risk factors for urosepsis or septic shock. Previous studies showed that female sex, older age, diabetes mellitus, extended-spectrum ß-lactamase-producing (ESBL)-positive E. coli, severe hydronephrosis, thrombocytopenia, hypoproteinaemia and immunosuppression are independent risk factors for urosepsis [1–3,13–17]. Patients with risk factors often require emergency drainage to prevent urosepsis progression [2,3,6]. However, some patients developed urosepsis and required intensive care even with timely drainage. In this study, 28 (18.7%) patients developed urosepsis after decompression, but none of them died because the early emergency drainage and intensive management in the intensive care unit at our hospital were successful. We found that the serum procalcitonin (PCT) in the urosepsis group was higher than in the no urosepsis group (28.09 ± 12.12 vs. 7.15 ± 3.86; p = .012). PCT is a precursor protein with 116 amino acids that is synthesized and secreted by thyroid C cells [18]. When infection or trauma occurs, PCT levels in vivo increased significantly within 12 to 48 h and remained stable. The PCT level can reflect disease severity [19]. A previous study showed that PCT is a tool for early diagnosis and monitoring of urosepsis after percutaneous nephrolithotomy [19]. Similarly, Cui et al. found that the PCT level can accurately predict urosepsis development [20]. Our data also suggest that PCT is an risk factor for patients with urosepsis after decompression.
The antifungal activity of caspofungin in combination with antifungals or non-antifungals against Candida species in vitro and in clinical therapy
Published in Expert Review of Anti-infective Therapy, 2022
Shan Su, Haiying Yan, Li Min, Hongmei Wang, Xueqi Chen, Jinyi Shi, Shujuan Sun
Candiduria is among the most common nosocomial infections [63]. Patients with foreign material in the urinary tract, notably kidney transplant recipients, are at particularly high risk [9]. A 39-year-old male underwent renal transplantation and multiple double-J catheterizations. Candiduria due to C. parapsilosis was then observed. Because candiduria persisted, an antifungal combination therapy with oral 5-flucytosine (500 mg bid) and continuous irrigation of caspofungin through a percutaneous calicostomy catheter (50 mg in 100 mL of 0.9% sodium chloride infused for 24 hours) was carried out. Because ureteroplasty was planned to permanently remove any foreign material in the urinary tract and to prevent any recurrence of candiduria or urosepsis, the therapy was continued for 47 days. Notably, no medullar toxicity was noticed. At a 2-year follow-up, all routinely performed urine cultures remained negative for Candida [64]. When 5-FC is chosen for the treatment of Candiduria, it needs to be combined with other antifungals because of side effects and drug resistance. Caspofungin is not listed in the general recommendation, yet patients with refractory infections could use it because of certain drug concentrations in nephridial tissues. Inevitably, there have been some situations in which antifungal resistance may occur. A report demonstrated that the combination of CSF and 5-FC caused resistance of C. glabrata to 5-FC, and the treatment then failed [65].
Renal trauma: a 6-year retrospective review from a level 1 trauma center in Denmark
Published in Scandinavian Journal of Urology, 2019
Sophia Liff Maibom, Mette Lind Holm, Niklas Kahr Rasmussen, Ulla Germer, Ulla Nordström Joensen
Of the 68 patients admitted to our urological ward, 13% (n = 9) were treated with one or more blood transfusions. From the other patients we could not obtain valid data on blood transfusions. Seven percent (n = 5) of the patients originally admitted to the urological ward were readmitted within 30 days, all because of infections. One patient had a grade III injury and four patients grade IV. Three patients were treated for urosepsis. One patient had re-bleeding and infection and was treated conservatively. The last patient (grade IV) was treated with antibiotics for infection and a follow-up CT revealed a pseudoaneurism and massive urinary extravasation; this patient was treated with an internal stent and the pseudo aneurism was embolized successfully. Only patients with symptoms of complications had repeat CT imaging performed in accordance with EAU guidelines [4] and patients with signs of infection who responded clinically to antibiotics did not have repeat CT imaging performed.