Renal and Ureteral Infections Infections of the urinary tract are common among patients whose ureteral excretion is compromised (Table 82-1). Candida, which has a predilection for the kidney, can invade either from the bloodstream or in a retrograde manner (via the ureters or bladder) in immunocompromised patients. The presence of "fungus balls" or persistent candiduria suggests invasive disease. Persistent funguria (with Aspergillus as well as Candida) should prompt a search for a nidus of infection in the kidney. Certain viruses are typically seen only in immunosuppressed patients. BK virus (polyomavirus hominis 1) has been documented in the urine of bone. | Chapter 082. Infections in Patients with Cancer Part 10 Renal and Ureteral Infections Infections of the urinary tract are common among patients whose ureteral excretion is compromised Table 82-1 . Candida which has a predilection for the kidney can invade either from the bloodstream or in a retrograde manner via the ureters or bladder in immunocompromised patients. The presence of fungus balls or persistent candiduria suggests invasive disease. Persistent funguria with Aspergillus as well as Candida should prompt a search for a nidus of infection in the kidney. Certain viruses are typically seen only in immunosuppressed patients. BK virus polyomavirus hominis 1 has been documented in the urine of bone marrow transplant recipients and like adenovirus may be associated with hemorrhagic cystitis. BK-induced cystitis usually remits with decreasing immunosuppression. Anecdotal reports have described the treatment of infections due to adenovirus and BK virus with cidofovir. Prevention of Infection in Cancer Patients Effect of the Environment Outbreaks of fatal Aspergillus infection have been associated with construction projects and materials in several hospitals. The association between spore counts and risk of infection suggests the need for a high-efficiency airhandling system in hospitals that care for large numbers of neutropenic patients. The use of laminar-flow rooms and prophylactic antibiotics has decreased the number of infectious episodes in severely neutropenic patients. However because of the expense of such a program and the failure to show that it dramatically affects mortality rates most centers do not routinely use laminar flow to care for neutropenic patients. Some centers use reverse isolation in which health care providers and visitors to a patient who is neutropenic wear gowns and gloves. Since most of the infections these patients develop are due to organisms that colonize the patients own skin and bowel the validity of such schemes is dubious and .
