Purpose: Pyelonephritis is quite common in patients with urolithiasis. This condition not only complicates the management of urolithiasis but also makes the treatment of associated urinary tract infections more challenging. The aim of this study is to identify the risk factors for pyelonephritis in patients with urolithiasis. Materials and Methods: A total of 8,273 patients with urolithiasis were retrospectively screened (2016–2025). From this cohort, 302 patients who developed pyelonephritis and 302 age- and gender-matched controls without pyelonephritis were randomly selected, forming a matched case–control study population. Demographic and clinical variables, including age, gender, stone size and location, number of stones, comorbidities, prior urinary operation, presence of a double-J ureteral stent, and urinary tract obstruction, were analyzed as potential risk factors. Results: Pyelonephritis developed in 302 patients (53.3% female). Hydronephrosis was the strongest independent risk factor, increasing risk nearly ninefold. Other significant risk factors included hypertension, diabetes mellitus, chronic kidney disease, malignant disease, immunosuppression, larger stone burden, multiple and bilateral stones, ureteral stent presence, and prior urinary operation. Each 1-mm increase in stone size was associated with a 2.3% increase in the risk of developing pyelonephritis. Bacteremia was detected in 66 patients, and urine cultures were positive in 229 patients. Escherichia coli was the most common pathogen, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa . Conclusions: Hydronephrosis, ureteral stent presence, a history of open or laparoscopic intervention, hypertension, and higher stone burden were independently associated with the development of pyelonephritis in patients with urolithiasis. Gram-negative bacilli were the most frequently isolated pathogens. Identification of these risk factors may support earlier recognition of high-risk patients and guide preventive and therapeutic decision-making. Prospective multi-center studies are needed to confirm these findings.

Background: Debridement, antibiotics, and implant retention (DAIR) is a commonly used tactic for the management of acute periprosthetic joint infection (PJI) following total hip arthroplasty. However, patient selection remains challenging, and predictors of treatment failure are not clearly defined. Patients and Methods: A retrospective cohort study was conducted in a single center including 48 patients treated with DAIR for acute hip PJI between 2000 and 2019. Clinical characteristics, comorbidities, microbiological findings, and perioperative variables were analyzed. Treatment failure was defined as the need for implant removal or exchange, resection arthroplasty, or chronic suppressive antibiotic therapy. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to explore factors associated with DAIR failure. Results: The mean age was 69.3 years. At a mean follow-up of 23.7 months, infection control was achieved in 83.3% of cases. Polymicrobial infection was significantly associated with treatment failure compared with monomicrobial infection (57.1% vs. 87.5%, p = 0.049). An exploratory predictive model demonstrated acceptable to good discriminatory performance in this exploratory cohort for DAIR outcome (area under the curve = 0.87). Conclusions: DAIR is an effective treatment option for selected patients with acute hip PJI. Polymicrobial infection was associated with treatment failure and should prompt careful consideration of alternative surgical strategies. Exploratory risk stratification models may assist in preoperative decision-making; however, validation in larger cohorts is required.

Necrotizing pneumonia (NP) is a rare entity seen to occur in 0.9%-7% of cases of community-acquired pneumonia in the pediatric population. Medical management remains the cornerstone of treatment. However, the destruction of both parenchyma and blood vessels impairs blood flow, limiting antibiotic concentrations and allowing the infection to persist. Although surgical management remains debated, some authors advocate for it in cases of medical treatment failure or extensive disease. The objective of this study was to present the surgical outcomes of our experience in treating NP in the pediatric population. A retrospective and observational study was conducted on all cases of NP in children who required surgical management between January 2022 and June 2024. During the study period, a total of 142 pediatric thoracic surgeries were performed, of which 25 involved patients with NP, who were included in our analysis. The median age was 3 years (2-4), with a nearly equal gender distribution (52% female, n = 13). The median duration of symptoms prior to the surgical procedure was 27 days (22-36), antibiotic therapy duration ranged from 5 to 18 days. On the basis of computed tomography findings regarding the extent of parenchymal involvement, 17 patients underwent sublobar resections, while 8 required lobar resections. While no statistically significant differences were observed in post-operative outcomes between groups, it is noteworthy that patients who underwent lobectomy experienced a higher frequency of complications. Surgical intervention, typically involving resection of necrotic lung tissue, may be considered in carefully selected pediatric patients who demonstrate persistent clinical deterioration despite optimized medical therapy and exhibit extensive parenchymal destruction on imaging. It is critical to tailor the treatment plan to the patient's clinical status and disease progression.

Short durations of anti-pseudomonal (Pa) antibiotic (ABX) therapy may seem low-risk; however, emerging data highlight subsequent multi-drug-resistant pathogens in previously treated patients. This study aims to evaluate the safety and efficacy of Pa versus non-pseudomonal (NPa) ABX prophylaxis in liver transplant (LT) recipients undergoing delayed biliary reconstruction (DBR). This is a single-center, retrospective study of LT recipients following a protocolized change in ABX prophylaxis when undergoing DBR between January 2017 and March 2023. Patients who received piperacillin-tazobactam or cefepime and metronidazole were assigned to the Pa cohort, and those who received ceftriaxone and metronidazole were assigned to the NPa cohort. Surgical site infection (SSI), any bacterial infection, total ABX days, and re-initiation or escalation of ABX therapy were compared between the Pa and NPa cohorts. Forty-eight patients were included in the study, with 27 in the Pa cohort and 21 in the NPa cohort. SSI at 30 days occurred in 10 (37.0%) compared with 4 (19.0%) patients in the Pa and NPa cohorts (p = 0.174), respectively. There were no differences in any bacterial infection, total ABX days, or re-initiation or escalation of ABX therapy. Thirty-day culture results yielded eight (72.7%) Enterococcus faecium species (seven in the Pa cohort) and no Pseudomonas aeruginosa. NPa ABX for peri-operative prophylaxis for patients who undergo DBR in LT was not associated with an increased infectious risk compared with broader-spectrum agents. The combined clinical and microbiological outcomes question the routine need for Pa therapy in this setting.

We evaluated the early diagnostic value of interleukin-6 (IL-6) for type I and type II necrotizing fasciitis (NF). A retrospective analysis was conducted of patients with NF between September 2020 and December 2024. They were divided into type I and type II NF. General clinical data, cytokines, and inflammatory markers were compared between the two groups. Threshold cytokine concentrations predictive of type I and type II NF were determined using receiver-operating characteristic (ROC) curve analysis. A total of 106 patients with NF were included in the study, 74 cases (69.8%) were type I NF, whereas 32 cases (30.2%) were type II. The most commonly identified pathogens associated with type II NF included staphylococcus (n = 16). Cytokine and inflammatory marker analysis of type I NF patients compared with type II NF demonstrated elevated plasma IL-6 concentration in type II NF, and IL-6 remained correlated with type II NF on logistic regression after confounder adjustment (p < 0.05). In addition, ROC analysis revealed plasma IL-6 as a strong type II NF predictor. The area under the curve of plasma IL-6 was 0.94 (95% confidence interval: 0.86-1.00, p < 0.05). At the optimal cutoff value of 75.10 pg/mL, the sensitivity and specificity reached 91% and 100%, respectively. Interleukin-6 can be a supplementary diagnostic marker for early differentiation between type I and type II NF. KY2022-R142.

Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies characterized by rapid tissue destruction, systemic toxicity, and high mortality. Early recognition and aggressive treatment are critical. A previously healthy 28-year-old male presented with one week of right shoulder and chest wall pain. Initially diagnosed with muscle strains via MRI, he re-presented to the emergency department five days later with hypotension. Blood cultures grew Streptococcus pyogenes, and imaging revealed extensive soft tissue involvement. Emergent fasciotomy and serial debridement revealed NSTI extending from the right shoulder to the scrotum and contralateral shoulder. Despite broad-spectrum antibiotics, debridements, continuous renal replacement therapy, and vasopressors, the patient developed multi-organ failure and died within 24 h of ICU admission. This case highlights the aggressive nature of NSTIs, the importance of early diagnosis, a non-classical presentation, and the potential for rapid progression to multi-organ failure and death even in young, previously healthy individuals.

Early and accurate diagnosis of pyogenic infections is essential to guide treatment and prevent complications like bacteremia, endocarditis, and death. Debate and controversy continue regarding the optimal specimen for microbiological diagnosis of pyogenic infections in emergency settings. Therefore, this study was conducted to evaluate concordance in the microbial yields obtained from the three techniques of sampling, i.e., pus swab, pus aspirate, and tissue biopsy. A total of 363 paired samples (swab and aspirate, swab and biopsy, aspirate and biopsy) from the same patient and site of infection received over one year were analyzed, retrospectively. Microbial yields, mixed bacterial growth, and contamination rates were compared among the three sample types. Tissue biopsies consistently provided the highest microbiological yield, outperforming both swabs (54.2% vs. 34.6%) and aspirates (43.8% vs. 38.5%). This difference in the diagnostic yield for paired tissue biopsy and swab samples was statistically significant (p value = 0.0038). Swabs exhibited high false negative rates (23.4%). The highest concordance was observed between tissue biopsy and aspirate (73.9%), indicating better reliability of these samples over swabs, which are superficial in nature. Tissue biopsies demonstrate the highest diagnostic yield for pyogenic infections, reinforcing their role as the gold standard. Pus aspirates offer a reliable alternative for less invasive sampling, while swabs are limited by their high false negative rates and inability to differentiate between colonizers and pathogens. In conclusion, employing appropriate sampling techniques based on the infection site can significantly enhance diagnostic precision and optimize patient care in emergency settings.

Geriatric patients injured in traumatic falls may present with either baseline or acquired cognitive impairment, preventing them from describing genitourinary symptoms. Thus, they are frequently given a screening urinalysis (UA) for possible urinary tract infection (UTI). However, according to the Infectious Diseases Society of America (IDSA), patients without systemic signs of infection should be assessed for other causes of falls and instead closely monitored. We conducted a study in our trauma system to assess UTI screening and treatment. We hypothesized that geriatric falls are likely to receive unnecessary urinalyses (UAs) and antibiotic agent treatment. Our trauma registry was queried for all patients with trauma aged 65 years and older between 2020 and 2023 for a ground-level fall with an initial Glasgow Coma Score (GCS) <15. Individual charts were reviewed for UTI testing and treatment data. Two hundred and sixty-eight out of 489 patients with geriatric falls (54.8%) had a screening UA performed. One hundred and fifteen (42.9%) patients had positive UAs. Of those with positive UAs, 69/115 (60%) patients were initially given antibiotic agent therapy for UTI treatment. There was no correlation between UTI treatment and either sepsis on presentation (p = 0.65), change in GCS (p = 0.21), or mortality rate (p = 0.16). Of all UAs done, 263/268 (98.1%) were given to patients without a systemic sign of infection. Geriatric patients with cognitive impairment that were injured in falls were consistently over-tested and overtreated for UTIs. Application of IDSA guidelines can potentially reduce unnecessary antibiotic agent use in these patients.