struvite and Escherichia-coli-Infections

To examine urine and stone bacteriology of struvite stone formers in a large cohort of patients undergoing percutaneous nephrolithotomy (PCNL).. A total of 1191 patients, with stone and urine cultures, treated with PCNL for renal calculi were included in the study. Statistical differences were assessed using Mann-Whitney U and T-tests.. Stone cultures were positive in 72% of patients with struvite stones. Urea-splitting organisms accounted for only half of the positive stone cultures. Enterococcus (9/50, 18%), Proteus (9/50, 18%), and Escherichia coli (6/50, 12%) were the most commonly identified organisms. Notably, two-thirds of struvite formers with negative stone culture had at least one positive culture for a urea-splitting organism on urine culture going back 1 year from the time of surgery. A majority (67%) of struvite stone cultures were found to be resistant to first- and second-generation cephalosporins.. The bacteriology of struvite stones has shifted away from traditional urea-splitting organisms and antibiotic coverage must be expanded to include organisms such as Enterococcus that do not respond to cephalosporins. Causative organisms may be found by going back in time to identify the initial organism that could have induced struvite stone formation to inform preventative therapy.

Topics: Adult; Enterococcus; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Proteus; Proteus Infections; Sepsis; Streptococcal Infections; Struvite; Tertiary Care Centers; Urea; Urinalysis

During a seven-year period (1975-1981) a total of 1325 patients hospitalized for stone disease were studied as to the occurrence of positive urine cultures. Urinary stones from 535 surgically treated patients were analyzed with infrared spectrophotometry and the relationships between stone composition, level of surgery and bacteriological strains were studied. Positive urinary cultures were found in 34% of the surgically treated patients and in 21% of those not operated upon. Among the surgically treated patients with urinary tract infection (UTI) E. coli was the most frequent microorganism (35%), followed by Proteus (28%). Patients with Proteus infection had the highest frequency of UTI episodes, most of which occurred before hospitalization. There was a higher frequency of magnesium ammonium phosphate (MAP) calculi among patients with Proteus infection than among those with non-Proteus infection, in whom no difference in stone composition was found. Patients infected with E. coli had more phosphate-containing stones (CaP+MAP) than non-infected patients. The highest frequency of oxalate calculi (CaOx+CaOx/CaP) was found among patients without infection. No E. coli infections were seen in male patients with CaP and MAP calculi. MAP stones were most often found in the kidney and oxalate stones in the ureter.

Topics: Calcium Oxalate; Calcium Phosphates; Escherichia coli Infections; Female; Humans; Kidney Calculi; Magnesium; Magnesium Compounds; Male; Middle Aged; Phosphates; Proteus Infections; Spectrophotometry, Infrared; Struvite; Urinary Tract Infections

Corynebacterium group D2 inoculated into normal human urine formed struvite crystals and an increase in pH and ammonium concentration after 24 h of incubation. Zinc disks dipped into a broth culture of this microorganism and inserted into the bladders of rats produced stones with a mean weight of 12.5 mg (ranging from 1 to 57.7 mg) after 12 days. Analysis of the infrared spectrum determined the stones to be composed of struvite. From these results its seems that stone formation by Corynebacterium group D2 may be possible both in vitro and in vivo, which may confirm a previous report involving these bacteria in human clinical encrusted cystitis.

Topics: Animals; Corynebacterium; Corynebacterium Infections; Cystitis; Escherichia coli; Escherichia coli Infections; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Magnesium Compounds; Phosphates; Proteus Infections; Proteus vulgaris; Rats; Rats, Inbred Strains; Struvite; Urinary Bladder Calculi

On the basis of routine clinical and laboratory investigations, one or more probable or possible causes of stone formation were established in 27% of upper urinary tract and 98% of bladder stone patients. In the upper urinary tract, causes were usually found for triple phosphate and pure calcium phosphate stones and rarely for pure calcium oxalate stones. Except for cystine stones and largely for triple phosphate stones there was no definite correlation between the composition of stone and causes. Uric acid and urate stones were often not associated with obvious causes, but their demonstration should lead to further investigations. In a small group of recurrent calcium stone formers examined for hypercalciuria, hyperoxaluria, hyperuricosuria, and renal tubular acidosis, positive findings were noted for 65%, but there was no consistent correlation between these findings and the types of stone. Stone analysis is most useful in so far as it identifies or excludes triple phosphate, cystine, and uric acid/urate stones. This may be done by simple chemical analysis. Certain rare components may, however, be overlooked, as will details of stone structure, unless crystallographic methods are employed.

Topics: Bacterial Infections; Calcium Oxalate; Calcium Phosphates; Cystine; Escherichia coli Infections; Humans; Magnesium; Magnesium Compounds; Phosphates; Struvite; Urinary Bladder Calculi; Urinary Bladder Neck Obstruction; Urinary Calculi