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Hsiao CY, Chen TH, Lee YC, Wang MC. Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection. Sci Rep 2021; 11:23333. [PMID: 34857804 PMCID: PMC8639828 DOI: 10.1038/s41598-021-02647-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022] Open
Abstract
To identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on AKI in patients with UTI. This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.299, 95% confidence interval [CI] 1.112–4.755, P = 0.025). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.451, 95% CI 1.369–4.389, P = 0.003) in UTI patients without hydronephrosis. The presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.
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Affiliation(s)
- Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Li T, Sun X, Li X, He Y. Flexible ureteroscopy lithotripsy combined with metallic ureteral stents for the treatment of patients with upper urinary tract calculi. Exp Ther Med 2020; 20:3330-3335. [PMID: 32855705 DOI: 10.3892/etm.2020.9038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 08/02/2019] [Indexed: 12/17/2022] Open
Abstract
Flexible ureteroscopy lithotripsy (FURS) is the most common treatment for patients with upper urinary tract calculi (diameter, <2 cm). The purpose of this prospective study was to assess the efficacy of FURS combined with metallic ureteral stents (MUS) for the treatment of upper urinary tract calculi. A total of 38 patients with upper urinary tract calculi were recruited in the present study, to compare the efficacy between FURS and FURS combined with MUS (FURS-MUS). The results demonstrated that FURS-MUS shortened operative time compared with FURS (35.2±1.2 vs. 57.4±1.7 min, respectively; P<0.01). Data also indicated that the clearance rate in FURS-MUS and FURS was decreased from 94.5 and 87.8%, respectively (P<0.05). FURS-MUS treatment decreased the duration of postoperative hospital stay compared with FURS (4.5±0.5 vs. 7.5±1.5 days, respectively; P<0.05). These data demonstrated that FURS-MUS significantly increased postoperative inflammation score compared with FURS (6.2±0.8 vs. 4.2±1.0, respectively; P<0.05). The complication rate and blood loss exhibited no significant difference between FURS-MUS and FURS (complication rate, 6.5% vs. 5.9%, respectively; blood loss, 4.2% vs. 4.6%, respectively). FURS-MUS significantly decreased inflammatory cytokines and risk of sepsis, and improved readmission rate, stone recurrence and progression-free survival compared with patients treated with FURS. In conclusion, these data suggested that FURS-MUS may be an efficient, minimally invasive and reproducible operation for patients with upper urinary tract calculi.
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Affiliation(s)
- Tian Li
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China.,Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
| | - Xiangzhou Sun
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xun Li
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China.,Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
| | - Yongzhong He
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China.,Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
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Al-Sunaidar KA, Prof Abd Aziz N, Prof Hassan Y. Appropriateness of empirical antibiotics: risk factors of adult patients with sepsis in the ICU. Int J Clin Pharm 2020; 42:527-538. [PMID: 32144611 DOI: 10.1007/s11096-020-01005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/22/2020] [Indexed: 12/29/2022]
Abstract
Background The appropriateness of antibiotics is the basis for improving the survival of patients with sepsis. Objective This study aimed to determine the appropriateness of empirical antibiotics, reasons for non-appropriate empirical antibiotics, risk factors of mortality, length of stay in intensive care unit (ICU-LOS) and Acute Physiology And Chronic Health Evaluation II (APACHE II) score predictors in adult patients with sepsis. Setting An adult ICU of a tertiary hospital in Malaysia. Methods A retrospective cohort study was conducted amongst patients with sepsis. Data were retrieved from the patients' files and computer system. Each case was reviewed for the appropriateness of empirical antibiotics based on ICU local guidelines, bacterial sensitivity, dose, frequency, creatinine clearance and time of administration of empirical antibiotics. Multivariable logistic and Cox regression modelling were performed to compute the adjusted association of receiving appropriate or inappropriate empirical antibiotics with ICU mortality. Multivariable linear regression modelling was performed using ICU-LOS and APACHE II scores. Main outcome measures were ICU mortality, severity score (APACHE II scores) and ICU-LOS. Results The total mortality rate amongst the 228 adult ICU patients was 84.6%. Males showed a higher mortality rate (119 [52.2%]) than females (74 [32.5%]). Inappropriate empirical antibiotics were significantly associated with mortality and ICU-LOS (P < 0.005). Results from multivariable logistic regression showed that the appropriateness of empirical antibiotics model was a potential predictor for survival (OR 0.395, 95% CI 0.184-0.850, P < 0.005). Results from simple linear regression indicated that the appropriateness of empirical antibiotics model was a remarkable predictor of decreasing ICU-LOS (R2 = 0.055, 95% CI - 7.184 to - 2.114, P < 0.001). Results from simple Cox regression suggested that the appropriateness of empirical antibiotics was a protective factor for ICU mortality (HR 0.610, 95% CI 0.433-0.858, P = 0.005). Multivariable Cox regression revealed that the administration of antibiotics exceeding the recommended dose based on creatinine clearance was a protective factor (HR 0.186, 95% CI 0.040-0.868, P = 0.032). Conclusion The appropriateness of empirical antibiotics is a good predictor for improving survival and decreasing ICU-LOS. Effective appropriateness of empirical antibiotics use and close adherence to the recommended dose can prevent the early mortality of patients with sepsis and acute renal failure.
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Affiliation(s)
- Khalid Ahmad Al-Sunaidar
- Faculty of Pharmacy-Universiti Teknologi Mara - Puncak Alam Campus, 42300, FF1, Level 10, Bandar Puncak Alam, Puncak Alam, Selangor, Malaysia.
| | - Noorizan Prof Abd Aziz
- Faculty of Pharmacy-Universiti Teknologi Mara - Puncak Alam Campus, 42300, FF1, Level 10, Bandar Puncak Alam, Puncak Alam, Selangor, Malaysia
| | - Yahaya Prof Hassan
- Faculty of Pharmacy-Universiti Teknologi Mara - Puncak Alam Campus, 42300, FF1, Level 10, Bandar Puncak Alam, Puncak Alam, Selangor, Malaysia
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Li Y, Li Q, Zhang G, Ma H, Wu Y, Yi Q, Jiang L, Wan J, Suo F, Luo Z. Time to positivity of blood culture is a risk factor for clinical outcomes in Staphylococcus aureus bacteremia children: a retrospective study. BMC Infect Dis 2019; 19:437. [PMID: 31101087 PMCID: PMC6525363 DOI: 10.1186/s12879-019-3993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S. aureus) is a common cause of bacteremia, which leads to significant morbidity and mortality. We investigated the relationship between time to positivity (TTP) and clinical outcomes in children with S.aureus bacteremia in the China. METHODS A retrospective study of Staphylococcus aureus bacteremia inpatient was performed in Children's Hospital of Chongqing Medical University in China between 29 January 2014 and 29 August 2017. TTP and clinical parameters were determined and analyzed. The receiver operating characteristic (ROC) curves were plotted for optimal cut-off selection, multivariate logistic regression tests were performed to evaluate the association between TTP and clinical outcomes. RESULTS Overall, 84 cases were enrolled. We stated that in-hospital mortality is significantly higher in the early TTP (≤17 h) than in the late TTP (> 17 h) group (57.14% vs 7.14%, P = 0.000). Septic shock occurred in 57.14% of patients with early TTP and in 18.57% of patients with late TTP (P = 0.002). Detailed multivariate and statistical analysis revealed that early TTP, need for vasoactive agent were independent risk factors of in-hospital mortality; early TTP, need for vasoactive agent and APACHE II score ≥ 15 were independent risk factors of septic shock incidence in S. aureus bacteremia children. CONCLUSIONS Overall, TTP of ≤17 h appeared to correlate with the worse outcomes for S. aureus bacteremia children. These results have important implications in the assessments and management of pediatric S. aureus bacteremia in a clinical setting. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Yuanyuan Li
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Qinyuan Li
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Guangli Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Huan Ma
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Yi Wu
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Qian Yi
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Lili Jiang
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Jiao Wan
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Fengtao Suo
- , Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,Department of Children's Hospital of Chongqing Medical University of Education, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 401122, China.
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