Emphysematous urinary tract infections
- Amy C Weintrob, MD
Amy C Weintrob, MD
- Associate Professor of Medicine
- The George Washington University and Veterans Affairs Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Emphysematous urinary tract infections (UTIs) are infections of the lower or upper urinary tract associated with gas formation. They may manifest as cystitis, pyelitis, or pyelonephritis.
Diabetes mellitus is a major risk factor for these infections and is also associated with an increased risk of asymptomatic bacteriuria and certain symptomatic UTIs such as cystitis, renal and perinephric abscess, and Candida infections [1-3]. These issues are discussed elsewhere. (See "Asymptomatic bacteriuria in patients with diabetes mellitus" and "Acute uncomplicated cystitis and pyelonephritis in women" and "Renal and perinephric abscess" and "Candida infections of the bladder and kidneys" and "Susceptibility to infections in persons with diabetes mellitus" and "Acute complicated cystitis and pyelonephritis".)
The pathogenesis of emphysematous UTIs is poorly understood. Elevated tissue glucose levels in diabetic patients may provide a more favorable microenvironment for gas-forming microbes. However, bacterial gas production does not fully explain the pathologic and clinical manifestations of emphysematous UTIs [4,5].
These infections are usually due to Escherichia coli or Klebsiella pneumoniae [4-8]; other causative organisms include Proteus, Enterococcus, Pseudomonas, Clostridium, and, rarely, Candida spp [9,10]. (See "Candida infections of the bladder and kidneys".)
Diabetes mellitus and urinary tract obstruction are the major risk factors for emphysematous urinary tract infections (UTIs). In different series, diabetes was present in more than 80 percent of patients with emphysematous pyelonephritis [4,6,11-13], at least 50 percent of patients with emphysematous pyelitis, and 60 to 70 percent of patients with emphysematous cystitis [5,14]. In addition, most patients were women, similar to the predominance of women in acute uncomplicated cystitis and pyelonephritis [4,5,14], and most patients were over age 60 [4,5,14].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- RISK FACTORS
- EMPHYSEMATOUS PYELONEPHRITIS AND PYELITIS
- Clinical features
- Differential Diagnosis
- - Prognostic classification
- - Risk factors for adverse outcomes
- - Suggested approach
- EMPHYSEMATOUS CYSTITIS
- Clinical presentation
- Differential diagnosis
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS