Update on Urinary Tract Infections Rakesh Khera
INDEX
ABCDEFGHIKLMNOPQRSTUVWXZ
Page numbers followed by f refer to figure and t refer to table.
A
Ablative surgery 11
Acid-fast bacillus
smear 4
urine cultures 4
Acinetobacter baumannii, carbapenem-resistant 113, 116
Acquired immunodeficiency syndrome (AIDS) 163
Acupuncture 71
Acyl-homoserine lactones 173
Adenosine triphosphate 10
Aldehydes 38
Amikacin 59, 120
Aminoglycosides 42, 119, 120
Ammonia 172
Amphotericin B 23, 60
Ampicillin 59
Amyloidosis 180
Antiadhesion substances 152
Antibiotics 52, 58, 119, 149
Antifungals, systemic 23
Anti-infective catheters, use of 105
Antimicrobial
coated catheters, use of 62
prophylaxis 71, 69
therapy 57, 58
Antireflux surgery, role of 90
Arteriosclerosis 39
Aseptic technique 62, 89, 101, 103
Aspergillus fumigatus 25
Asymptomatic bacteriuria, catheter-associated 62
Autonephrectomy 8, 195
Azithromycin 148
Azotemia 26
Aztreonam 59, 115
B
Bacteremia 82, 95, 115
gram-negative 57
nosocomial 57
Bacteria 66, 75, 138
Bacterial
adhesins 167
armor 171
factors 127
interference 150
persistence 66
pili, phase variation of 169
virulence 165, 170
Bacteriophages 151
Bacteriuria 58, 68, 74–76, 81, 102
asymptomatic 51, 60, 74, 76, 78, 80–83, 89, 95, 99, 161, 170
catheter-associated 51
incidence of 66
significant 160
symptomatic 94
Bacteroides 163
Balloon dilatation 12
Bedaquiline 10
Beta-lactamase inhibitors 42
Biofilm 134, 135
acquire three-dimensional structure 139f
architecture and genesis of 138
bacterial 134
detachment 140
formation steps 139f
infection 147
treatment of 147
maturation 140
phenotype 141
Biopsy 8, 90
Bladder 2, 8, 24, 76
abnormalities, functional 67
biopsy 8
catheterization, prolonged postoperative 87
epithelium 76
filling under direct vision 8
lesions 2
malignancy 33
mucopolysaccharide coating of 76
mucormycosis of 26f
thimble 2, 8
Blood
cultures 56
pressure 45
Bloodstream infection 99
Boari flap 12
Bone marrow 114
Bubbly renal parenchyma 40f
Burning micturition 195
C
Calyces, distorted 8
Calyx, dilated 8
Candida 15, 16, 96
albicans 16, 17, 23, 27, 33, 152, 162
fungemia 77
glabrata 17, 20, 23, 60, 61
krusei 17, 23
parapsilosis 17
pyelonephritis 19
tropicalis 17
urinary tract infection 16
Candidal colonization 19
Candidemia 25
Candiduria 16, 20, 25, 52, 60, 99
Capsular polysaccharide 166
Carbapenem 59, 115, 116, 119, 120
Carbapenemase-producing organisms 59
Carbon dioxide 34, 172
Carcinoma bladder 12
Catheter
and drainage tubes, disconnection of 62
biofilm, micrograph of 146f
care 101
aseptic 52, 97
early removal of 62
inserter, lower professional training of 97
insertion checklist 106f
insertion of 62
removal 62
replacement 62
Cefepime 59
Ceftazidime 59
Ceftriaxone 59
Cell to cell communication system 143
Cellulose 139
Cephalexin 71
Cephalosporins 42, 119
Cervical immunoglobulin A 75
Chemotherapy 8
Chloramphenicol 119, 122
Chromatography, thin layer 145
Cilastatin 59
Ciprofloxacin 59
Cirrhosis 53
Citrobacter 162
Clarithromycin 148
Closed drainage systems, use of 62
Clostridium
difficile colitis, nosocomial 57
perfringens 163
septicum 33
Coccidioides immitis 16
Coccidioidomycosis 15
Coexisting renal carcinoma 11
Colistimethate 59
Colistin 115
Colonic acid 139
Colony forming units 74, 94, 160
Coma 38
Complex closed drainage systems, use of 62
Computed tomography 41, 179, 183, 186, 193, 196
imaging 190
scan 7, 41
axial image of 222
Confusion 38
Contrast enhanced ultrasonography 182
Cork screw ureter 8
Cowper ducts 182
Cranberry products, use of 62
Cryptococcus neoformans 16
Cystitis 82, 165
cyclophosphamide-induced 180
emphysematous 46, 181f, 196
radiation 180
superficial 12
Cystocele 66, 68
Cystogram 182
Cystoplasty, augmentation 12
Cystoscopy 8
Cystourethrography, micturating 180
Cytomegalovirus 88
D
Dehydration 112
Deoxyribonucleic acid 5, 165
Diabetes 45, 112
mellitus 19, 32, 52, 67, 75, 87, 97, 114
Diarrhea 120
Diguanylate cyclases 150
Dihydro-nitroimidazooxazole derivative 10
Disseminated intravascular coagulation 42
D-mannose 70
Doripenem 59, 120
Double J stent 44
early removal of 89
placement of 12
Doxycycline 115, 121
Dysreflexia, autonomic 96
Dysuria 3, 38
E
Empirical initial antimicrobial therapy 42
Endocarditis 95
Enterobacter 68, 162
Enterobacteriaceae 34, 54, 67, 70, 111, 146f
carbapenem-resistant 113, 116
Enterococcus faecalis 126, 152, 162
Enzyme inhibitors 150
Epididymectomy 11
Epididymis 2
Ertapenem 59, 120
Eryptococcus neoformans 33
Erythromycin 148
Escherichia coli 17, 33 46, 54, 67, 68, 76, 87, 96, 111, 117, 120, 122, 125, 152, 162, 165, 166, 168, 171, 190
heat-killed uropathogenic 126, 127
resistance pattern of 119
uropathogenic 125, 140
Estrogen deficiency 52
Extended spectrum B lactamases 54, 59, 113, 116
External matrix, formation of 139, 139f
Extracellular polymeric substance 135
F
Fallopian tubes 10
Febrile episodes 98
Fecal soiling 68
Fever 38, 39, 59, 96
Fine needle aspiration 8
Flank pain 9, 38
Fluconazole 25, 60, 89
Fluorescence in situ hybridization 5, 145, 146f
Fluorescent dye techniques 4
Fluorofamide 150
Fluoroquinolones 42, 69, 71, 115, 116
Foley's catheter 112
Fosfomycin 59, 71, 115, 116, 121
Fungal infections 15, 60, 89
Funguria 27
Fusobacterium anaerobic cocci 163
G
Gardnerella vaginalis 162
Gastrointestinal tract 112
Genitourinary abnormalities 75, 112
Genitourinary
surgery 60
system 15
tract 1, 16, 68
tuberculosis 1, 3, 12
diagnosis 3
etiology 1
investigations 3
pathophysiology 1
treatment 8
Gentamicin 120
Gerota's fascia 39, 186
Glomerulonephritis membrane 170
Glomerulosclerosis 39
Glycocalyx 135
Glycolipids 139
Glycyclins 120
Golf-hole appearance 2
Graft dysfunction 88
Granulomatous diseases 186
H
Hematuria 38, 195
Hemodialysis 52
Hemolysin 169
Hemorrhage 8
interstitial 39
High blood glucose level 38
Histoplasma capsulatum 16
Huang and Tseng classification 36, 37, 43
Human immunodeficiency virus infection 33
Human leukocyte antigen 160
Hydrogen 34
Hydronephrosis 2, 9, 193f
Hydrophilic catheters, use of 62
Hydroureteronephrosis 186f
Hypertension 11
I
Imipenem 59, 120
Immunoglobulin G 126
Indwelling urinary catheters 19, 101, 102, 114
Infarction 39
Infections
atypical 90
severe 59
Infectious Diseases Society of America 51, 74, 81
Inflammatory cell infiltration, acute 39
Intensive care unit 50, 94, 114, 116
Interferon-gamma release assays 4
Intracellular bacterial communities 125, 140
Iontophoresis 149
Isonicotinic acid hydrazide 9
K
Kerr's kink 8
Ketoacidosis, diabetic 38
Kidney 1, 8
malakoplakia of 196
nonfunctioning 11
Kidney, ureter and bladder 34, 39, 68, 185f
plain radiograph of 179
radiograph of 180f, 181f
Klebsiella pneumoniae 33, 42, 45, 54, 77, 96, 113, 126, 162, 173
L
Lactic acid 75
Lactobacillus acidophilus 75
Leukocyte count 38
Levofloxacin 59
Linezolid 59
Liposomes 150
Low energy surface acoustic waves 151
Low estrogen state 75
M
Macrolides 148
Magnetic resonance 192
imaging 21, 41, 184, 189, 194
diffusion-weighted 41
urography 184
Malakoplakia 195, 196
Matrix-assisted laser desorption 145
Meningitis 115
Menopause 75
Meropenem 59, 120
Metabolic disorders 186
Methenamine salts, use of 62
Michaeli classification 34
Microbial
cure 112
failure 112
infections 135
Microhematuria 38
Minimum biofilm
eradication concentration 148
inhibitory concentration 148
Minocycline 121
Morganella morganii 54, 77, 126, 173
Moth eaten appearance of calyces 8
Mucorales 27
Mucormycosis 22f
diagnosis of 27
Multidetector computed tomography 183, 184
Multidrug-resistant
bacteria, gastrointestinal decolonization of 71
tuberculosis, treatment of 10
Multiplanar reconstruction 183
Multiple cortical cysts 190f
Multiple organ failure 46
Mycobacterial growth indicator tubes 163
Mycobacterium
avium-intracellulare 1
bovis 1
fortuitum 1
haemophilum 88
kansasii 1
tuberculosis 1, 5, 6, 90, 163, 164
direct test, amplified 5, 6
xenopi 1
N
Nanoparticles 149
Nausea 38, 120
Nephrectomy 11, 44, 90
delayed 44
emergency 44
laparoscopic 44
Nephrolithiasis 45
Nephropathy, diabetic 33
Nephroscopy 27
Nephrostomy 24, 25, 27
percutaneous 112
Nephrouretrectomy 11
Netilmicin 120
Neutropenia 97
Nitrofurantoin 70, 71
Nitrogen 38
Noncontrast computed tomography, coronal section of 186f, 191
Nosocomial infection 135
Nucleic acid 139
amplification 5
O
Obstructed transplant ureters, treatment of 90
Oral diarylquinoline 10
Orchitis 88
Organic acids 38
Oxygen 38
P
Pain, renal 195
Pancreatitis, acute 187
Pandrug resistance 112
Papillary necrosis 8, 195
Pelvicalyceal system 192
Peptide nucleic acid 5
Perinephric tissue 34
Perirenal abscess 187
Periurethral Littré glands 182
Phantom calyx 8
Piperacillin 59
Pipe-stem ureters 2, 8
Planktonic bacteria, reversible attachment of 139f
Platelet count 38
Pneumaturia 32, 38
Pneumocystis jirovecii 33
Pneumonia 115
Polycystic kidney disease 33, 87
Polyglucosamine 139
Polymerase chain reaction 5, 6, 21, 56, 90, 146
Polymyxin 115, 116, 120
Povidone-iodine solution 62
Praziquantel 91
Prednisone, high-dose 10
Prerenal azotemia 33
Prophylactic
antibiotic therapy 62
antimicrobials, use of 62
Prostate 2
benign enlargement of 90
transurethral resection of 2
Prostatitis 115, 197
bacterial 51
candidal 19
chronic 197
Proteins 139
Proteinuria, severe 38
Proteus
mirabilis 33, 42, 54, 57, 77, 106, 107, 141, 152, 162, 171–173
vulgaris 126, 141, 173
Providencia
rettgeri 141, 173
stuartii 77
Proximal hydroureteronephrosis, bilateral 187f
Pseudomonas
aeruginosa 77, 96, 113, 138, 143, 149, 162, 172, 173
biofilms 137
fluorescens 139
multidrug-resistant 113
Psoas hitch 12
Purified protein derivative tuberculin 3
Purple urine bag syndrome 97
Putty kidney 1
Pyelitis, emphysematous 36
Pyelogram, intravenous 34, 39
Pyelography
intravenous 195
retrograde 7
Pyelonephritis 38, 41, 56, 59, 82, 87, 99, 112, 165, 169, 179, 186, 188f, 192
acute 33, 89, 184, 185, 187
chronic 39, 188, 190f
complicated 79
emphysematous 32, 39, 45, 46, 56, 181f, 190, 191f, 192, 194
simple 79
Pyonephrosis 192, 193f
Pyuria 38, 39, 79, 98
Q
Quinolones 42, 119
Quorum sensing inhibitors 151
R
Reconstructive surgery 11
Renal
abscess 35, 56, 187, 189f
anomaly, congenital 180
cell carcinoma 33
cortical cyst 189f
disease 97
failure 58, 104
function impairment, acute 44
papilla, destruction of 1
parenchyma 34, 36f, 37f, 76, 193f
acute bacterial infection of 32
pelvicalyceal system 185
transplant recipient 88, 90
Roche Amplicor Mycobacterium tuberculosis PCR test 5
S
Salmonella typhi 164
Salmonellosis 88
Salmonelluria 89
Saprophytic opportunistic fungi 27
Schistosoma haematobium 90
Schistosomiasis 87, 180
Self-start intermittent therapy 71
Sepsis 33, 82
Serratia 68, 162
Shock 38, 44, 46, 50
Spermatic cord 10
Spinal cord injury 75, 76
Split bolus technique 183
Staghorn calculus 179, 194f
Staphylococcus
aureus 54, 77, 95, 149, 164
epidermidis 151, 162
saprophyticus 162, 173
Sterile pyuria 79, 90, 195
Steroids 10
Streptococcus mutans 137
Stress urinary incontinence 68
Sulfamethoxazole 71
Suprapubic
catheterization 62
tubes 112
T
Tamm-Horsfall protein 76, 159
Tazobactam 59
Testis 2
Tetracyclines 121
Thrombocytopenia 38, 44, 45
Tigecycline 115, 116, 120
Tobramycin 59, 120
Transrectal ultrasonography, high-resolution 7
Trimethoprim 71
Tubercle bacilli, demonstration of 3
Tuberculosis 1, 88, 179, 194
Tuberculous bacilli 4
Tuberculous peptide nucleic acid 5
Tumors 180
U
Ultrasonography 7, 41, 182, 193
Ureaplasma urealyticum 162
Ureter 2, 8, 10
Ureteral orifice, fibrosis of 2
Ureteric
reimplantation 12
stents 52, 75
stricture 11
Ureteritis 88
tuberculous 2
Ureteroureterostomy 12
Urethral
catheters 75
contamination 74
length 75, 76
secretions 104
Urethrogram, retrograde 180, 182
Urinary bladder 75, 87
mucormycosis of 222
Urinary calculi, treatment of 90
Urinary catheters 100
early removal of 89
insertion of 103
maintenance of 103
perioperative management of 102
Urinary complicating factors 112
Urinary drainage 90
Urinary fluoroquinolones 59
Urinary incontinence 61, 67
Urinary infections 51, 54
complicated 51
uncomplicated 51
Urinary obstruction 53, 58
acute anatomic 61
functional 61
Urinary retention 52
Urinary tract 77, 100
infection 33, 50, 51, 55, 57, 61, 66, 68, 87, 115, 115t, 134, 159, 162, 179
aspergillus 25
bacterial 18
biofilm in 140
catheter-associated 16, 50, 51, 59, 62, 94, 97t, 100, 101t, 116, 141, 162
fungal 15, 18, 60
healthcare-associated 53, 94
multidrug-resistant 111
nosocomial 54
pathogenesis of 124
prophylaxis of 90
radiology of 179
recurrent 66, 67, 69, 90, 91, 124
risk factors for 52t
severe 53
vaccines for 124
instrumentation of 52
isolated mucormycosis of 27
obstruction 19, 188
Urinary tuberculosis 8t
Urine 74
culture 58
output, rigorous monitoring of 52
routine 80
studies 4
Urogenital surgery, history of 67
Urography, intravenous 5, 7, 8t, 179, 180
Urolithiasis 112
Urologic surgery 53
Uropathogens, adhesion of 125
Urosepsis 59, 89
Urothelial tract 185f
Urothelium, infection of 19
V
Vaccination strategies 126
Vaginal estrogen 69
replacement 69
Vancomycin 59
resistant enterococci 59
Vascular thrombosis 39
Vesicoureteral reflux 2, 76, 188
Vomiting 38, 120
W
Wan classification 34, 45
X
Xanthogranulomatous pyelonephritis 46, 179, 192, 193
Z
Ziehl-Neelsen stain 4
Zuckerkandl fascia 186
Zygomycetes 27
×
Chapter Notes

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fm1Update on Urinary Tract Infections
fm2fm3Update on Urinary Tract Infections
Editors Rakesh Khera MBBS MS MCh (Urology) DNB (Urology) MNAMS Director Uro-Oncology and Training Programme Department of Urology, Robotics and Renal Transplant Medanta—The Medicity Gurugram, Haryana, India Foreword Naresh Trehan
fm4
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Update on Urinary Tract Infections
First Edition: 2018
9789352701728
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fm5Dedicated to
My teachers
Dr Ravinder Narang the man who taught me what surgery is and how to do it. The basics and the way forward was shown by him.
Dr Rajesh Ahlawat the man who showed me what urology means and how to become good in it. He showed me the advances in urological surgical care.fm6
fm7Contributors fm11Foreword
Urinary tract infection is a very common but underestimated problem. In India there are more than 10 million reported cases of UTI per year. These figures reflect the enormity of it and most of us would get to see their fair share in the outpatients department. The varied spectrum that UTI presents itself is mind boggling cutting across age groups, sex, associated comorbidities, immune-suppression/compromised status, endemic areas and many more. The aging population in India is increasing due to better medical facilities and early diagnosis of disease. This also increases the age related UTIs in men due to BPH and females too due to hormone related changes. These people are to be treated well as they are underprivileged physically and monetarily. Another issue that we all face is the increasing trends of nosocomial infections which constitute about 40% of the total infections. With the constantly changing spectrum of organisms and the varied antibiograms, we as clinicians are perpetually flummoxed in selecting appropriate treatment protocols. Add to it the ever increasing use of higher antibiotics at the primary care level leading to early antibiotic resistance and leaving us with very little scope for subsequent treatment. Another vexing problem is lack of application of the current existing guidelines which confuses the issue even further.
We all know that episodes of UTI can be effectively managed and treated with antibiotics. This book helps attract the attention towards the present scenario in UTI in various fields. This starts right from microbiology labs to the ICU setting.
The current Update on Urinary Tract Infections is about solving clinical problems that we face daily in treating urinary tract infections. Authors here have reviewed the current literature and tried to update the subject of UTI under various important categories. This actually is an evidence-based book on UTI which has been continuously updated over the last 10 years.fm12
In this book, authors have concisely compiled the current research and updates on the subject, presenting it as a ready- reference which can be easily used by all clinicians for updating their knowledge for the future. Such knowledge gives the readers information helping them to reconsider and optimise their own ways of treating the problem.
Dr Naresh Trehan
Chairman and Managing Director
Medanta—The Medicity
Gurugram, Haryana, India
fm13Preface
Urinary tract infection (UTI) is one of the most common problems faced by all physicians in the community or the hospital. Over the past many years there has been a shift in the understanding of UTI. The field continues to be fertile subject for both basic science and clinicians. The way of looking at UTI has changed over time but many old ways still remain.
I have asked the authors to identify the most relevant clinical questions in their subspeciality, perform schematic literature search and apprise the reader about the same.
Interestingly, our paradigms continue to change. I hope this book represents the most comprehensive discussions of UTI. The techniques and technologies illustrated do represent the most popular, well utilised and enduring management options of today.
I hope the readers find this issue provocative, informative and very applicable in managing their patients of UTI.
Rakesh Kherafm14
fm15Acknowledgments
All my teachers who have taught me new things to keep me abreast of the situation in medical science. My family (Saloni, Shagun, Suhani & OSCAR), parents and my friend (Dr Prasun Ghosh) were all very instrumental in their help.
My special thanks to my daughter Shagun Khera who drew the bacterial image on the cover of this book.
Every journey begins with a step and this editorship is a first one for me. I hope it brings more good work for me.