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Emphysematous urinary tract infections

Amy C Weintrob, MD
Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


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].

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Literature review current through: Nov 2017. | This topic last updated: Oct 08, 2017.
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