emphysematous UTI

 Q: 82 years old diabetic female is admitted to ICU with urosepsis. The plain abdominal film showed emphysematous Urinary Tract Infection (UTI). What is the most common cause of emphysematous UTI? (select one) 

A) Escherichia coli 

B) Candida 

 Answer: A

Emphysematous UTI can either be in the upper or lower urinary tract and is hallmarked with gas formation. The most common risk factor is diabetes mellitus. This gas formation is not fully understood as the most common pathogens are the same who are the usual culprits in simple UTI i.e., Escherichia coli and Klebsiella pneumonia. 

Other pathogens that may be involved are Proteus, Enterococcus, Pseudomonas, Clostridium, Streptococcus, Cryptococcus, and sometimes polymicrobial. Candida is rarely implicated. It is suggested that hyperglycemia provides a suitable environment for gas-formation.

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References:

1. Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: illustrative case report and review of the literature. Medicine (Baltimore) 2007; 86:47. 

2. Chang SW, Yen DH, Fung CP, et al. Klebsiella pneumoniae renal abscess. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:721. 

3. Hildebrand TS, Nibbe L, Frei U, Schindler R. Bilateral emphysematous pyelonephritis caused by Candida infection. Am J Kidney Dis 1999; 33:E10.