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논문분류	춘계학술대회 초록집
제목	Urosepsis and acute kidney injury after urine alkalization via percutaneous nephrostomy
저자	Seong Gyu Kim, In Hee Lee, Ki Sung Ahn, Gun Woo Kang
출판정보	2019; 2019(1):
키워드	Urosepsis \| Acute kidney injury \| urine alkalization \| Percutaneous nephrostomy
초록	"Urine alkalization via percutaneous nephrostomy (PCN) has been used in the treatment of urinary stone. Severe complications such as sepsis have not been reported after urine alkalization. Enterobacter cloacae is the rare pathogen of urinary infections, but more likely associated with nosocomial infection than other pathogens. We report a case of rapidly progressive urosepsis due to Enterobacter cloacae after urine alkalization via PCN.A 77-year-old male visited the emergency department because of severe chilling sensation immediately after urine alkalization via PCN. He was hospitalized for post-renal acute kidney injury due to left ureter stone and underwent PCN insertion 3 weeks ago. After 2 times of extracorporeal shock wave lithotomy, intermittent urine alkalization at the urology outpatient department was performed. After admission, the white blood cell count decreased rapidly from 8,300/mm3 to 1,000/mm3 and C-reactive protein was increased. The level of creatinine was 2.8 mg/dL. Bacteriuria and pyuria were showed in urinalysis and left percutaneous drainage. Urosepsis after procedure was suspected and antibiotic treatment immediately with hydration was started. On the 2nd day of admission, fever subsided and white blood cell count increased from 1,000/mm3 to 17,000/mm3(neutrophil 92.5%). Extended-spectrum beta lactamases producing Enterobacter cloacae was isolated from blood culture only 12 hours after sampling, and then same organism revealed on urine culture. On the 3rd day of admission, C-reactive protein decreased and leukocytosis subsided. And the level of creatinine decreased to 1.7 mg/dL. Bacterial growth was no longer observed in blood and urine culture on the 3rd day of admission. He discharged with oral antibiotic. One week later, he visited outpatient department without fever."
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