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2018 ; 7
(1
): 90-93
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Renal vein thrombosis complicating severe acute pyelonephritis with renal
abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase
producing Escherichia coli
#MMPMID29327131
Assimakopoulos SF
; Kraniotis P
; Gogos C
; Marangos M
CEN Case Rep
2018[May]; 7
(1
): 90-93
PMID29327131
show ga
Acute pyelonephritis might be complicated by the formation of renal and perirenal
abscesses and very rarely by renal vein thrombosis, which is a life-threatening
condition. The main causative agents of acute pyelonephritis are
enterobacteriaceae with the incidence of extended-spectrum beta-lactamase
(ESBL)-producing strains increasing worldwide. We present the case of a
71-year-old Greek man with history of diabetes mellitus and recent
hospitalization, who suffered from severe pyelonephritis with renal abscesses
formation and associated bacteraemia caused by ESBL-producing Escherichia coli,
complicated by extensive thrombosis of the ipsilateral renal vein and its
branches, protruding also in the inferior venal cava. Our patient was effectively
treated with anticoagulants and targeted antibiotic therapy, respectively,
consisted of low molecular weight heparin transitioned to oral acenocoumarol for
3 months and 2-week course of intravenous meropenem followed by oral fosfomycin
for additional 3 weeks as quidded by clinical and computed tomographic follow-up.
In conclusion, in complicated urinary infections, caused by ESBL-producing
enterobacteriaceae, oral fosfomycin might represent an effective option for
step-down therapy of carbapenems, allowing the shortness of the duration of
patient's hospitalization and carbapenem use.