Klebsiella pneumoniae ESBL forming spheroplasts in the fresh and unstained urine sediment

Poloni, José Antônio Tesser; Meinerz, Gisele; Monteiro, Alexandre; Keitel, Elizete; Rotta, Liane Nanci

doi:10.5935/0101-2800.20160038

Cited by 3 publications

(2 citation statements)

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“…If laboratory professionals involved in the urine sediment examination are not able to recognize these unusual bacterial forms, they might be misinterpreted as erythrocytes or fungi. Poloni et al have published a case report of spheroplasts present in unstained urine sample of a patient that had recurrent episodes of urinary tract infection ( 12 ). In the urine culture of that patient, Klebsiella pneumoniae ESBL was identified.…”

Section: Discussionmentioning

confidence: 99%

Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report

Nikler¹,

Biljak²,

Čičak³

et al. 2019

Biochemia Medica

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IntroductionIt has already been reported that subinhibitory concentrations of β-lactam antibiotics can cause abnormal changes of bacterial forms, such as spheroplasts. Herein we report a case of Croatian male patient with Escherichia coli spheroplasts present in urine after treatment with tazobactam, on the tenth day of hospitalization. The aim of this report is to emphasize the inability of imaging based automated urine analysers to recognize some relatively uncommon forms of bacterial presentation in urine sediment.Materials and methodsDuring routine urine analysis, unusual particles were observed in patient urine. Urine sediment was examined by two urine analysers: Atellica 1500 (Siemens, Germany) and Iris iQ200 (Beckman Coulter, USA). Additionally, urine was sent for culture testing to Microbiology department.ResultsBoth urine analysers didn’t indicate presence of bacteria in urine sediment. Unusual particles observed on the tenth day were classified as erythrocytes by both instruments. Dipstick test showed blood trace and microscopic analysis revealed bacteria in urine. Urine culture was positive for Escherichia coli. Careful examination of urine sediment has confirmed that shapes present in urine were abnormal bacterial forms called spheroplasts.ConclusionsImaging based automated urine analysers are not able to recognize bacterial spheroplasts in urine sediment misclassifying it as erythrocytes. Microscopic examination remains the gold standard for urines with blood trace or negative blood, in which erythrocytes are reported by urine analyser in urine sediment. Failure to identify and follow up such cases may lead to inaccurate treatment decisions and puts patient safety at risk.

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Section: Discussionmentioning

confidence: 99%

Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report

Nikler¹,

Biljak²,

Čičak³

et al. 2019

Biochemia Medica

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“…Indeed, bacteria can be found deformed in urine sediment, presenting elongated, thin, and filamentous forms, sometimes with a swollen and ball-like part of each bacteria, called spheroplasts (Figure 9). These spheroplasts can be seen after the use β-lactamic antibiotics [22,23]. Both filamentous forms and spheroplasts usually are seen with sizes much larger than bacteria usually presents, potentially leading to misidentification of these bacterial-deformed forms as fungal structures.…”

Section: Urinary Particlesmentioning

confidence: 99%

Urine Sediment Findings and the Immune Response to Pathologies in Fungal Urinary Tract Infections Caused by Candida spp.

Poloni

Rotta

2020

JoF

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Fungi are pathogenic agents that can also cause disseminated infections involving the kidneys. Besides Candida, other agents like Cryptococcus spp. can cause urinary tract infection (UTI), as well as other non-yeast fungi, especially among immunocompromised patients. The detection and identification of fungi in urine samples (by microscopy and culture) plays an essential role in the diagnosis of fungal UTI. However, variable cutoff definitions and unreliable culture techniques may skew analysis of the incidence and outcome of candiduria. The sediment analysis plays a key role in the identification of fungal UTI because both yeasts and pseudohyphae are easily identified and can be used as a clinical sign of fungal UTI but should not be overinterpreted. Indeed, urine markers of the immune response (leukocytes), urine barriers of tissue protection (epithelial cells), and urine markers of kidney disease (urinary casts) can be found in urine samples. This work explores the manifestations associated with the fungal UTI from the urinalysis perspective, namely the urinary findings and clinical picture of patients with fungal UTI caused by Candida spp., aspects associated with the immune response, and the future perspectives of urinalysis in the diagnosis of this clinical condition.

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Spheroplasts, poorly known but clinically relevant particles of urinary sediment

Falbo¹,

Fogazzi

Sala³

et al. 2021

Clinica Chimica Acta

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Klebsiella pneumoniae ESBL forming spheroplasts in the fresh and unstained urine sediment

Cited by 3 publications

References 0 publications

Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report

Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report

Urine Sediment Findings and the Immune Response to Pathologies in Fungal Urinary Tract Infections Caused by Candida spp.

Spheroplasts, poorly known but clinically relevant particles of urinary sediment

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