Behaviour of urinary excretion of lysozyme in renal diseases and in urinary tract infections (author's transl)]

Urinary excretion of lysozyme was investigated in a group of 66 patients with various renal diseases, nephrolitiasis and urinary tract infections. The results obtained demonstrate that the amount of the enzyme excreted is related to the entity of tubular damage whereas is not with glomerular damage. No correlation was found between lysozyme excretion neither to the degree of proteinuria neither to the amount of leukocytes and bacteria in the urine. In patients with urinary infections urinary lysozyme increases only when there is a tubular injury of some entity. In 90 pediatric patients with urinary infection and pyelonephritis lysozyme in the urine was found only in two cases. Therefore urinary lysozyme determination cannot be considered for the detection of early tubular injury and is not a helpful diagnostic tool in urinary tract infections.     

Management of urinary tract infections in children

Urinary tract infection is common in children. The presentation varies with age. Younger children exhibit protean signs. Diagnosis is dependent on the demonstration of significant bacteriuria in a properly collected and handled urine sample. The approach to treatment depends on the degree of illness at presentation, the presence of structural urinary tract abnormalities, and the age of the patient. Pathophysiology of urinary tract infection is dependent on interactive factors of the host and of the invading microorganism. Urinary tract abnormalities have significant impact on the management of children with urinary tract infections, both medically and surgically. Of particular importance is the observation that renal damage usually occurs within the first 5 years of life, and treatment delay in some young patients may have significant consequences. The overall prognosis in children with urinary tract infection is favorable.     

Differential diagnostic use of interleukin patterns in patients being monitored after transplantation

BACKGROUND AND AIM: We investigated how far the determination of selected interleukins in bodily fluids of patients who had received kidney allografts can help to confirm the diagnosis of complications after transplantations. MATERIALS AND METHODS: Levels of soluble interleukin-2-receptor, interleukin 6 and interleukin 8 were determined in serum and urine of 79 patients. According to the type of diagnosis obtained with histological, serological and microbiological methods and to the clinical course, the groups "stable graft function without complication", "allograft rejection", "cytomegalovirus infection", "systemic extrarenal bacterial infection", "urinary tract infection" and "pyelonephritis" were created. RESULTS AND CONCLUSIONS: The activation of the immune system in different ways depending on the trigger substance (alloantigen, virus, bacterium) and the possibility to differentiate systemic and local processes cause typical patterns of interleukin levels in serum and urine in conjunction with the above mentioned complications after kidney transplantation. Cytomegalovirus infections and systemic extrarenal bacterial infections differ from rejection by the unchanged urine interleukins IL 6 and IL 8, the local urinary tract infections differ from rejection by the unchanged serum interleukins. Acute pyelonephritis differs from rejection by the significantly higher serum IL 6 level. During our daily clinical work, the practical interleukin determinations were proven to be an important tool for early and differential diagnosis of complications after kidney transplantation.     

Infectious complications of advanced cancer

 We present a retrospective study of the frequency, pattern, and management of infections in advanced cancer. Three hundred ninety-three patients were admitted to an acute care palliative medicine unit in an 8-month period for evaluation and palliation of cancer-related symptoms and complications. One hundred fifteen had at least one positive bacteriological culture, and 100 of these patients were evaluable. One hundred fifty-two infections and 192 isolates were identified. Sixty-eight patients had polymicrobial infections. Sixty-six patients had urinary tract infections. Forty-one were found to have multisystemic infections. Eighty-one had invasive devices; 32 had more than one invasive device. Fifty-three were taking corticosteroids at the time of infection. Only 3 were neutropenic. Urinary tract infections were significantly more common in those taking corticosteroids. The median duration of antibiotic treatment was 11 days and the median hospital stay, 14 days. Twenty-eight patients died in the hospital; 10 of those who died had lung cancer, which was a statistically significant observation. In conclusion, infections are an underrecognized but common complication in nonneutropenic hospitalized patients with advanced solid tumors. Urinary tract infections appear to be associated with the use of corticosteroids. Lung cancer patients are at greater risk for fatal infections. Infections increase morbidity in debilitated patients with solid tumors, are a frequent cause of hospital admission, and are associated with significant mortality. Published online: 31 May 2000     

The Effects of Viral Infections on Renal Transplants and Their Recipients

A prospective study of viral infections occurring after 188renal transplants in 167 patients showed active cytomegalovirus(CMV) infection after 52 per cent of transplantations. All 37CMV seronegative cases who received grafts from seronegativedonors remained free of infection, while 24 (70·6 percent) of 34 seronegative recipients whose donors were seropositivedeveloped primary CMV infection (p<0·001). The diagnosisof 92 per cent of these primary infections was made betweenone and two months after grafting. Secondary CMV infection wasfound in 71(62 per cent) of 114 seropositive cases, and thefrequency of infection was not affected by the CMV status ofthe renal donor. Neither acute rejection episodes nor totalgraft rejections were associated with primary or secondary infections.CMV was isolated from a colonic abscess and the relationshipof the virus to the intestinal disease is discussed. Herpes simplex virus was isolated from 47 per cent of casesand 32 per cent had an increase in antibody titre. Zoster wasseen in nine patients, representing an incidence of 3·4per cent per year. Other viral or mycoplasmal infections diagnosedincluded 71 due to respiratory tract pathogens, and a singlecase of hepatitis B. None of these infections was particularlysevere or frequent and no association with graft rejection wasdetected.     

Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System.

OBJECTIVE: To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States. DESIGN: Analysis of ICU surveillance data collected through the National Nosocomial Infections Surveillance (NNIS) System between 1992 and 1997. SETTING: Medical ICUs in the United States. PATIENTS: A total of 181,993 patients. MEASUREMENTS AND MAIN RESULTS: Nosocomial infections were analyzed by infection site and pathogen distribution. Urinary tract infections were most frequent (31%), followed by pneumonia (27%) and primary bloodstream infections (19%). Eighty-seven percent of primary bloodstream infections were associated with central lines, 86% of nosocomial pneumonia was associated with mechanical ventilation, and 95% of urinary tract infections were associated with urinary catheters. Coagulase-negative staphylococci (36%) were the most common bloodstream infection isolates, followed by enterococci (16%) and Staphylococcus aureus (13%). Twelve percent of bloodstream isolates were fungi. The most frequent isolates from pneumonia were Gram-negative aerobic organisms (64%). Pseudomonas aeruginosa (21%) was the most frequently isolated of these. S. aureus (20%) was isolated with similar frequency. Candida albicans was the most common single pathogen isolated from urine and made up just over half of the fungal isolates. Fungal urinary infections were associated with asymptomatic funguria rather than symptomatic urinary tract infections (p < .0001). Certain pathogens were associated with device use: coagulase-negative staphylococci with central lines, P. aeruginosa and Acinetobacter species with ventilators, and fungal infections with urinary catheters. Patient nosocomial infection rates for the major sites correlated strongly with device use. Device exposure was controlled for by calculating device-associated infection rates for bloodstream infections, pneumonia, and urinary tract infections by dividing the number of device-associated infections by the number of days of device use. There was no association between these device-associated infection rates and number of hospital beds, number of ICU beds, or length of stay. There is a considerable variation within the distribution of each of these infection rates. CONCLUSIONS: The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.     

Urinary tract infection in children

Up to 7 percent of girls and 2 percent of boys will have a symptomatic, culture-confirmed urinary tract infection by six years of age. Urinary tract infection may be suspected because of urinary symptoms in older children or because of fever, nonspecific symptoms, or failure to thrive in infants. Urine dipstick analysis is useful for ruling out urinary tract infections in cases with low clinical suspicion. However, urine culture is necessary for diagnosis of urinary tract infections in children if there is high clinical suspicion, cloudy urine, or if urine dipstick testing shows positive leukocyte esterase or nitrite activity. Despite current recommendations, routine imaging studies (e.g., renal ultrasonography, voiding cystourethrography, renal scans) do not appear to improve clinical outcomes in uncomplicated urinary tract infections. Oral antibiotics are as effective as parenteral therapy in randomized trials. The optimal duration of antibiotic therapy has not been established, but one-day therapies have been shown to be inferior to longer treatment courses.     

Urinary tract infection in renal transplant recipients

Urinary tract infection (UTI) is common in renal transplant recipients. Frequency of UTIs depend on many factors such as age, female gender, kidney function, co-morbidity, type and amount of immunosuppression, urological instrumentation and/or the follow-up period (short term or long term) after kidney transplantation. UTI may worsen graft and patient survival. A significant proportion of renal transplant recipients with UTIs may develop acute pyelonephritis (APN), which is an independent risk factor for deterioration of graft function. Renal transplant recipients with UTIs are often clinically asymptomatic as a consequence of immunosuppression. UTI, however, may progress to APN (particularly in the early post-transplant period), bacteraemia and the full blown picture of urosepsis. Strategies for long term prophylaxis and antimicrobial treatment of UTI in renal transplant recipients are discussed.     

A Rapid Quality Control Initiative to reduce the incidence of urinary tract infection in the paediatric intensive care patient--Part one

Urinary tract infection is one of the common bacterial infections in children and can lead to substantial morbidity. If the infection results in renal scarring, various long-term risks include hypertension and renal insufficiency. Nosocomial urinary tract infections (NUTI) in children occur with varying frequency with approximately 60–80% of these infections being strongly correlated with urethral instrumentation. This paper presents stage one of a Rapid Quality Control Initiative to reduce the incidence of NUTI in the paediatric patient at King Faisal Specialist Hospital and Research Centre.     

脊髓损伤病人的尿路感染问题

通过对相关文献的回顾 ,了解脊髓损伤病人尿路感染的发病因素、诊断、预防和治疗的研究现状。尿路感染仍然是脊髓损伤病人最常见的并发症 ;导尿是非常重要的危险因素 ;依据症状、体征、脓尿和尿培养细菌数诊断尿路感染 ;不提倡用抗生素预防尿路感染和治疗无症状性菌尿 ;氟喹诺酮类药物治疗这类病人有很好的疗效。     

A case of urinary tract infection caused by Kluyvera ascorbata in an infant: case report and review of the literature

We experienced a case of urinary tract infection in a 3-month-old child caused by Kluyvera ascorbata. The authors report the case and review the literature regarding Kluyvera urinary tract infection exclusively in children. Kluyvera infection, which had been extremely rare, has increasingly been reported, including urinary tract infection. A prompt identification of Kluyvera species in clinical infections is important. Recognition of its disease-producing potential and the subsequent initiation of effective antimicrobial coverage are essential for appropriate management in the pediatric population.     

Urinary excretion of glycosaminoglycans in urological disease

Altered urinary excretion of glycosaminoglycans (GAG) has been reported in patients with nephrolithiasis, with chronic glomerulonephritis, and incipient diabetic nephropathy, but evaluation of urinary GAG has not been reported in infections and proliferating diseases of the urinary tract. Urinary excretion of GAG was measured in 50 patients with idiopathic calcium nephrolithiasis (ICN) of whom 20 had associated urinary tract infection, in 20 subjects with recurrent infection of the urinary tract (UTI), and in 18 patients with bladder papillomatosis. Mean values were significantly lower in ICN, increased in papillomatosis, and in the normal range in UTI.     

Catheterization and urinary tract infections: microbiology

Patients with urinary catheters are a substantial proportion of the total patient population and catheter care is an important area of nursing practice. Urinary tract infection associated with catheterization is known to be the most common nosocomial (hospital-acquired) infection. Urinary tract infections can be caused by exogenous microorganisms or endogenous faecal or urethral microorganisms. The different microorganisms which are responsible for causing urinary tract infections have particular characteristics. Many microorganisms form a biofilm, a living layer of cells which stick to the surfaces of the catheter and the catheter bag. Biofilms not only lead to urinary tract infections, but also they are associated with encrustation and catheter blockage. The article considers the microorganisms implicated in catheter-associated urinary tract infections and aims to develop an increased awareness of the characteristics of different pathogens which could lead to enhanced nursing practice and improved patient care.     

Pediatric kidney transplantation during the COVID-19 pandemic

A waiting list for non-emergency transplant medical care was recommended in the first half of 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Hence, the number of kidney transplants temporarily declined. However, the waiting list for transplant medical care was lifted in the latter half of 2020 with the establishment of a polymerase chain reaction test system and the spread of infection prevention. The basic stance is to recommend vaccination to post-transplant recipients, recipients, and donors who are scheduled to undergo transplantation, and their families, with the start of vaccine therapy in 2021. The mortality rate of patients undergoing kidney transplants who had COVID-19 is slightly higher than healthy persons, and acute kidney injury was reported to lead to graft loss. However, pediatric cases of severe disease are rare and without deaths. Kidney transplantation medical care will be continuously provided by implementing infection prevention and treatments based on the latest evidence, promoting donated kidney transplantation, and hoping that pediatric patients with renal failure will grow up healthy, both physically and mentally, and become independent members of society, just like healthy children.     

Renal Doppler sonographic and histologic findings in post-transplant primary cytomegalovirus disease

Cytomegalovirus (CMV) infections frequently develop in renal transplant patients. The transplanted kidney may be not only the source of infection but also the target for it. We report a case of primary CMV infection in a seronegative patient who received a graft from a seropositive cadaveric donor. The onset of CMV was clinically apparent on post-transplant day 22. Interestingly, soon after transplantation, the patient developed a long-lasting graft dysfunction episode for which diffuse endothelial-cell swelling was the most relevant finding at biopsy. On sonography, renal graft vascular impedance deteriorated and improved repeatedly during the follow-up period. We postulate that the patient had CMV-induced immunogenic-mediated endothelial-cell injury.     

The prognostic significance of acute renal failure after renal transplantation in patients treated with cyclosporin

We studied 733 cadaveric renal transplant patients (747 transplants) under cyclosporin immunosuppression, to: (i) establish the risk profile for acute renal failure (ARF) after renal transplantation in a unit using many sub-optimal donors; (ii) assess the long-term prognostic relevance of ARF; and (iii) explore the synergistic prognostic significance of delayed graft function and acute rejection during the early post-transplant period. Transplanting from a non-heart-beating or elderly donor, protracted cold ischaemia, haemodialysis immediately before transplant surgery, poor HLA matching, and grafting to a hypersensitized recipient without residual renal function, all independently predicted delayed graft function. This delay had no detrimental effect on patient or graft survival, but prolonged ARF was associated with increased mortality from infection. Late markers of graft dysfunction (poor graft function, proteinuria, hypertension) were highly prevalent among grafts affected by ARF, specially in prolonged ARF. Delayed graft function and early acute rejection showed a definite, albeit not strong, additive impact on late graft survival, and also on the prevalence of late markers of graft dysfunction.      

The impacted ureteral stone

ABSTRACT: Urinary tract calculi and infections are common causes of presentation to the emergency department. Computed tomography kidney-ureter-bladder is the initial imaging study of choice in patients presenting with symptoms of urinary tract calculi. As clinical evidence of superimposed infection can be atypical or absent, it is crucial to identify subtle imaging findings that suggest this complication. We report here a case of acute ureterolithiasis with missed evidence of superimposed infection on the initial computed tomography kidney-ureter-bladder. The patient subsequently developed urosepsis complicated by critical limb ischemia requiring amputation of all 4 extremities. The case became the topic of a malpractice suit.     

Susceptibility of Recent Bacterial Isolates to Cefdinir and Selected Antibiotics among Children with Urinary Tract Infections

Background: Cefdinir, an extended‐spectrum cephalosporin administered orally, is approved by the U.S. Federal Drug Administration for treatment of skin and respiratory tract infections. During the last two years at the authors' institution, this agent has been used as an off‐label treatment for urinary tract infections in children. Objectives: To evaluate antimicrobial susceptibility testing data in children to determine whether there is support for this prescribing practice. Methods: In this retrospective study (2003–2004), the authors compared the susceptibility patterns of urinary pathogens to cefdinir and selected antibiotics in children who were evaluated for urinary tract infections in an urban tertiary academic pediatric emergency department. Pathogens (community acquired vs. opportunistic or nosocomial) were categorized as susceptible, indeterminate, or resistant on the basis of antibiotic susceptibility breakpoints. The frequency of these categorizations for individual drugs was determined. Results: Seven hundred five isolates were recovered from urine during the study period. Pathogens isolated most frequently were Escherichia coli, Klebsiella spp, and Proteus spp. Of 431 isolates retained in the data set, 412 (95.6%) were susceptible to cefdinir. This rate was comparable or superior to rates observed for other antibiotics: 49.4% for ampicillin, 84.9% for trimethoprim–sulfamethoxazole, 88.4% for cefazolin, 93.3% for nitrofurantoin, 94.2% for ticarcillin–clavulanate potassium, 97.5% for gentamicin, and 97.7% for ceftriaxone. Cefdinir, however, had lower activity (64.7%) against 17 bacterial isolates categorized as opportunistic or nosocomial pathogens. Conclusions: Cefdinir provides good coverage against common pathogens responsible for urinary tract infections in children and compares favorably with other oral and parenteral antibiotics that are used in the empiric treatment of this infection.     

Cytokines and cell adhesion molecules in the inflammatory response during acute pyelonephritis

Urinary tract infection is a common bacterial infection of childhood. Renal parenchymal scarring, a recognised complication of urinary tract infection, is responsible for up to 24% of children entering end-stage renal failure. Why acute inflammation results in renal scarring in some children whilst in others complete resolution occurs without scarring is at present poorly understood. This article reviews the role of the cytokines, adhesion molecules and growth factors in the inflammatory response during acute pyelonephritis and renal parenchymal scarring. We hypothesize that inter-individual variability in cellular response may in part be responsible for this variable clinical outcome.