Refractory Salmonella infection resulting in nephrectomy

Area of Science:

• Nephrology
• Infectious Diseases
• Urology

Background:

• Non-typhoidal Salmonella (NTS) typically causes gastroenteritis but can lead to focal non-gastrointestinal infections.
• Refractory Salmonella pyelonephritis is a rare complication, often associated with underlying renal pathology like nephrolithiasis and hydronephrosis.

Purpose of the Study:

• To present a case of refractory multidrug-resistant Salmonella pyelonephritis.
• To discuss the challenges in managing atypical Salmonella infections in the urinary tract.
• To highlight nephrectomy as a rare but effective treatment option.

Main Methods:

• Case presentation of a patient with persistent Salmonella bacteriuria and pyelonephritis.
• Description of failed antibiotic therapies and percutaneous nephrostomy (PCN) drainage.
• Details of successful management with laparoscopic robotic-assisted left nephrectomy.

Main Results:

• Patient presented with refractory Salmonella pyelonephritis, nephrolithiasis, and hydronephrosis.
• Multiple antibiotic courses and PCN drainage failed to clear the multidrug-resistant Salmonella infection.
• Laparoscopic robotic-assisted left nephrectomy successfully eradicated the bacteriuria and resolved the infection.

Conclusions:

• Atypical Salmonella infections can present as refractory pyelonephritis, posing significant management challenges.
• Nephrectomy, though rare, can be a necessary intervention for non-functional infected renal units in such cases.
• This case underscores the importance of considering surgical intervention for persistent, treatment-resistant Salmonella urinary tract infections.