Gas-Forming Infection of the Kidneys Due to Facultative Anaerobes

A 66-year-old female patient was admitted to the intensive care unit in septic shock (quick sepsis-related organ failure assessment [qSOFA] 2/3, leukocytes 31 gigaparticles/liter, procalcitonin 323 ng/mL, lactate 3 mmol/L) with acute renal failure and hyperosmolar hyperglycemic syndrome (blood glucose 37 mmol/L) in the setting of newly diagnosed type 2 diabetes mellitus. Computed tomography showed bilateral emphysematous pyelonephritis, which, due to its severity, required emergency placement of a nephrostomy tube in the right kidney and left nephrectomy. Escherichia coli (wild type) was cultivated in renal tissue samples as well as in blood cultures (under both aerobic and anaerobic conditions). No other pathogens were detected. Initial antibiotic therapy with meropenem/clindamycin was subsequently de-escalated to ampicillin/sulbactam. End stage renal disease requiring dialysis persisted after the patient‘s recovery. Emphysematous pyelonephritis is extremely rare, associated with a high mortality rate, and is often caused by enterobacteria (in particular E. coli), which are capable of producing gas as a byproduct of their facultative anaerobic metabolism. Risk factors include female sex and diabetes.

Translated from the original German by Christine Rye

Cite this as: Rößler S, Kiria N, Schneider R: Gas-forming infection of the kidneys due to facultative anaerobes.

Figure.

Coronal slice of the native CT study. The arrows mark distinct bilateral air inclusions (black) in the renal parenchyma; on the left, the renal parenchyma is almost completely replaced by air inclusions.