Incidence of renal and perinephric abscess in diabetic patients: a population-based national study. Epidemiol Infect. 2011;139:229-235. [PMID: 20478081 DOI: 10.1017/s095026881000107x]

Comparative risk of infection of medications used for type 2 diabetes

INTRODUCTION

Glucose-lowering drugs pose a potential infection risk among individuals with type 2 diabetes. The U.S. Food and Drug Administration has issued safety warnings regarding increased risks of urinary tract infections (UTIs) and genital infections with sodium-glucose cotransporter 2 (SGLT2) inhibitors. However, the infection risk associated with other glucose-lowering drugs remains unclear. We conducted a PubMed database search to review the infection risk of glucose-lowering drugs, focusing on meta-analysis of randomized controlled trials.

AREAS COVERED

We described the infection risks associated with SGLT2 inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucose-like peptide-1 receptor agonists, metformin, and thiazolidinediones, covering infections of the genitourinary, respiratory, and gastrointestinal systems, including skin and soft tissue infections (SSTIs).

EXPERT OPINION

SGLT2 inhibitors are associated with a higher genital infection risk, while their UTI risk remains inconclusive. DPP-4 inhibitors could be a treatment option for those intolerant to SGLT2 inhibitors, given their lower genital infection risk compared to placebo. Uncertainty persists regarding the risks of respiratory infections, gastroenteritis, and SSTIs with SGLT2 inhibitors. Limited evidence is available regarding the impact of DPP-4 inhibitors on respiratory infections. Additional research is needed to determine the comparative infection risk of other glucose-lowering drugs.

Successful treatment of giant perinephric abscess associated with decompensated cirrhosis caused by hepatitis B and alcohol consumption: A case report

We describe the case of a 67-year-old male with decompensated liver cirrhosis caused by hepatitis B virus and alcohol consumption who presented with diarrhea and fever. Contrast CT of the abdomen revealed giant perirenal abscess. Klebsiella pneumoniae ssp pneumoniae was cultured from pus in perirenal abscess but not the blood. Haematogenous spread may have resulted in perirenal abscess in this case. The patient was successfully treated by percutaneous drainage, antimicrobial therapy and albumin infusion. With high mortality rates, early diagnosis and effectively treatment of perirenal abscess is required to improve the prognosis of patients.

Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction for the treatment of perinephric abscess: a case series

Background

Drainage is indicated in many patients with a perinephric abscess (PA). Surgical drainage is associated with trauma and slow recovery, while percutaneous drainage can be ineffective in some patients. We report on 11 patients with PA treated by percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction under local anesthesia.

Methods

This case series included 11 PA patients operated on from January 2013 to June 2020. All patients received percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction. Data, including operation time, volume of intraoperative blood loss, volume of intraoperative pus suction, time of postoperative drainage tube indwelling, time to restore normal body temperature, length of postoperative hospital stay, and intraoperative and postoperative complications, were collected.

Results

The age of the patients was 59 (53–69) years. Eight, six, two, and two patients had hypertension, type 2 diabetes, rheumatoid arthritis, and renal calculi, respectively. The operations were successful forall11 patients. Eight, two, and one patients required one, two, and three channels, respectively, to clear their abscess. The average operation time was 44 (30–65) min, and intraoperative blood loss was 16 (10–20) ml. The volume of intraoperative pus suction was 280 (200–400) ml, time of postoperative drainage tube indwelling was 8.2 (6–12) days, and time to restoring normal body temperature was 0.8 (0.5–2) days. The average postoperative hospital stay was 9.8 (7–14) days. No severe intraoperative or postoperative complications occurred. The postoperative follow-up time was typically 4.8 (3–8) months, and there were no recurrences.

Conclusion

Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction might be a feasible method for treating PA.

Thiazolidinediones and reduced risk of incident bacterial abscess in adults with type 2 diabetes: A population-based cohort study

AIM

Previous research has suggested that peroxisome proliferator-activated receptor-gamma (PPAR-γ) may play an important role in immunomodulation. We aimed to examine the association between thiazolidinediones, PPAR-γ agonists and incidence of bacterial abscess among patients with type 2 diabetes.

MATERIALS AND METHODS

This retrospective cohort study between 2000 and 2010 included 46 986 propensity (PS)-matched patients diagnosed with type 2 diabetes. We compared the incidence of bacterial abscess, including liver and non-liver abscesses, between patients treated with metformin plus a thiazolidinedione (M + T, N = 7831) or metformin plus a sulfonylurea (M + S, N = 39 155). Data were retrieved from a population-based Taiwanese database. We applied Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), comparing M + T and M + S after PS matching.

RESULTS

During a median follow-up of 4.5 years, the incidence rate of bacterial abscess was lower with M + T than with M + S treatment (1.89 vs 3.15 per 1000 person-years) in the PS-matched cohort. M + T was associated with a reduced risk of bacterial abscess (HRs after PS matching, 0.58; 95% CI, 0.42-0.80 for total bacterial abscess; 0.54; 95% CI, 0.28-1.07 for liver abscess; 0.59; 95% CI, 0.41-0.85 for non-liver abscess). Results did not change materially after accounting for unmeasured confounding factors using high-dimenional PS matching and differential censoring between regimen groups. Rosiglitazone and pioglitazone, in combination with metformin, produced similar reductions in risk of all abscess outcomes.

CONCLUSION

We found that M + T may provide a protective benefit in reducing the incidence of bacterial abscesses. These findings merit further investigation.

Invasive Group B streptococcus: multiloculated perinephric abscesses treated with percutaneous drainage

Group B streptococcus infections (GBSI) are commonly associated with neonates and pregnant women, but may also affect nonpregnant adults. Among its spectrum of manifestations, perinephric abscess (PA) is exceedingly rare. Comorbid conditions such as diabetes mellitus (DM) and immunosuppression increase the risk of GBSI. We describe a 61-year-old Vietnamese man with compensated alcoholic cirrhosis, who presented with acute encephalopathy following subacute, progressive abdominal pain. He was afebrile and hemodynamically stable. Laboratory data were remarkable for leukocytosis, thrombocytopenia, azotemia, and pyuria. He was found to have two right-sided PA measuring 15 × 10 × 11 cm and 4.6 × 2.7 × 7.8 cm, requiring interval placement of multiple percutaneous drains. Culture from abscesses revealed beta-hemolytic Group B streptococcus (GBS). His course was complicated by contiguous spread to abdominal wall and paraspinal musculature, as well as a new diagnosis of type 2 DM. Along with drainage, a prolonged course of intravenous antimicrobial treatment led to abscess resolution. Given the rising number of unusual clinical presentations of GBSI, this bacteria should be considered as a part of the microbiological differential diagnosis of PA, especially in conditions leading to immunosuppression.

The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection

Background

Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI.

Materials and Methods

Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables.

Results

Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS.

Conclusion

Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.

Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state: A 14-year time-series analysis

This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Monthly temperature averaged from 19 meteorological stations across Taiwan was correlated with monthly rate of admission for DKA or HHS, respectively, using the 'seasonal Autoregressive Integrated Moving Average' (seasonal ARIMA) regression method. There was an inverse relationship between ambient temperature and rates of admission for DKA (β=-0.035, p<0.001) and HHS (β=-0.016, p<0.001), despite a clear decline in rates of DKA/HHS admission in the second half of the study period. We also noted that winter was significantly associated with increased rates of both DKA (β=0.364, p<0.001) and HHS (β=0.129, p<0.05) admissions, as compared with summer. On the other hand, fall was associated with a significantly lower rate of HHS admission (β=-0.016, p<0.05). Further stratified analyses according to sex and age yield essentially similar results. It is suggested that meteorological data can be used to raise the awareness of acute hyperglycemic complication risk for both patients with diabetes and clinicians to further avoid the occurrence of DKA and HHS.

Splenectomy and risk of renal and perinephric abscesses: A population-based cohort study in Taiwan

Little epidemiological research is available on the relationship between splenectomy and renal and perinephric abscesses. The purpose of the study was to examine this issue in Taiwan.We conducted a population-based retrospective cohort study using the hospitalization dataset of the Taiwan National Health Insurance Program. A total of 16,426 participants aged 20 and older who were newly diagnosed with splenectomy from 1998 to 2010 were assigned to the splenectomy group, whereas 65,653 sex-matched, age-matched, and comorbidity-matched, randomly selected participants without splenectomy were assigned to the nonsplenectomy group. The incidence of renal and perinephric abscesses at the end of 2011 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for risk of renal and perinephric abscesses associated with splenectomy and other comorbidities including cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis.The overall incidence rate of renal and perinephric abscesses was 2.14-fold greater in the splenectomy group than that in the nonsplenectomy group (2.24 per 10,000 person-years vs 1.05 per 10,000 person-years, 95% CI 2.02, 2.28). After controlling for sex, age, cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis, the multivariable regression analysis demonstrated that the adjusted HR of renal and perinephric abscesses was 2.24 for the splenectomy group (95 % CI 1.30, 3.88), when compared with the nonsplenectomy group. In further analysis, the adjusted HR markedly increased to 7.69 for those comorbid with splenectomy and diabetes mellitus (95% CI 3.31, 17.9).Splenectomy is associated with renal and perinephric abscesses, particularly comorbid with diabetes mellitus. In view of its potential morbidity and mortality, clinicians should consider the possibility of renal and perinephric abscesses when patients with splenectomy present with fever of unknown origin.

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study

AIM: To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.

METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed.

RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice. Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders.

CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

Effect of diabetes on mortality and length of hospital stay in patients with renal or perinephric abscess

OBJECTIVES

We compared the risk of in-hospital mortality and the length of hospital stay between diabetic and non-diabetic patients hospitalized for renal or perinephric abscess.

METHOD

The data analyzed in this study were retrieved from Taiwan's National Health Insurance claims. The risk of in-hospital mortality and the length of hospital stay were compared between 1,715 diabetic patients, hospitalized because of renal or perinephric abscess in Taiwan between 1997 and 2007, and a random sample of 477 non-diabetes patients with renal or perinephric abscess.

RESULTS

The in-hospital mortality rates from renal or perinephric abscess for the diabetic patients and the non-diabetic patients were not different, at 2.3% and 3.4%, respectively. However, diabetes was significantly associated with a longer length of hospital stay among patients with renal abscess, by 3.38 days (95% confidence interval [CI]: 1.59-5.17).

CONCLUSIONS

Diabetes does not increase the risk of in-hospital mortality from renal or perinephric abscess. Nevertheless, appropriate management of patients with diabetes and concurrent renal or perinephric abscess is essential to reduce the length of hospital stay.

Acute conditions affecting the perinephric space: imaging anatomy, pathways of disease spread, and differential diagnosis

The perinephric space is an important, central compartment of the retroperitoneum which may host various acute conditions. Imaging evaluation of the perinephric space requires an understanding of its anatomy and the pathways of disease spread to and from other retroperitoneal compartments. Numerous acute conditions can affect the perinephric space and may occur in isolation, extend from nearby retroperitoneal structures, or be part of a systemic condition. Familiarity with the key imaging findings of acute conditions affecting the perinephric space is imperative to facilitate diagnosis and guide treatment. The purpose of this article is to review and illustrate the relevant anatomy, pathways of disease spread, and acute pathology encountered during cross-sectional imaging evaluation of the perinephric space.