title: Community-acquired methicillin-resistant Staphylococcus aureus as a cause of rapidly progressing pyelonephritis with pyonephrosis, necessitating emergent nephrectomy.
abstract: In this article, we describe the first, to our knowledge, reported case of severe bacteremic upper urinary tract infection with pyonephrosis-in the context of prior chronic urinary tract disease-caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The patient presented with fever and constitutional symptoms, and computed tomography revealed extensive renal parenchymal infection along with a staghorn calculus and dilatation of the pyelocalyceal system. His clinical condition rapidly deteriorated, and he developed uncontrollable sepsis, necessitating an emergent nephrectomy. Significant pyonephrosis was noted during surgery. Blood cultures yielded MRSA, and molecular analysis (by polymerase chain reaction) of the MRSA strains from blood and wound fluid showed that they were Panton-Valentine leukocidin positive and they also possessed SCCmecA type IV. Postoperatively, the patient was treated with intravenous vancomycin for 3 weeks and had a favorable outcome.
authors.affiliation: Fifth Department of Internal Medicine, Alexandra University Hospital, Athens, Greece. ioannisbaraboutis@yahoo.gr
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Baraboutis
authors.forename: Maria
authors.initials: M
authors.lastname: Koukoulaki
authors.forename: Helen
authors.initials: H
authors.lastname: Belesiotou
authors.forename: Evaggelia
authors.initials: E
authors.lastname: Platsouka
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papastamopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kontothanasis
authors.forename: Katerina
authors.initials: K
authors.lastname: Kontogianni-Katsarou
authors.forename: Eleftheria P
authors.initials: EP
authors.lastname: Tsagalou
authors.forename: Olga
authors.initials: O
authors.lastname: Paniara
authors.forename: Athanasios T
authors.initials: AT
authors.lastname: Skoutelis
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000150:complications / Q000382:microbiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011704:Pyelonephritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D053018:Pyonephrosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin