title: Sepsis complicated by brain abscess following ESWL of a caliceal kidney stone: a case report.
abstract: A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscesso (55x75mm) in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors). The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate.
authors: Unità di Nefrologia, Ospedale di Pescia, Pescia, Italy.
authors: Alessandro
authors: A
authors: Capitanini
authors: Unità di Nefrologia, Ospedale di Pescia, Pescia, Italy.
authors: Luca
authors: L
authors: Rosso
authors: Unità di terapia intensiva, Ospedale di Pescia, Pescia, Italy.
authors: Laura
authors: L
authors: Giannecchini
authors: Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.
authors: Ophelia
authors: O
authors: Meniconi
authors: Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.
authors: Adamasco
authors: A
authors: Cupisti
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: ESWL; Lithotripsy; Urolithiasis