Abstract
We had difficulty in diagnosing two cases with urinary tract infection with urease-producing bacteria. <Case 1> A 71-year-old woman was admitted under emergency for disturbance of consciousness. Her consciousness level was Glasgow coma scale (GCS) E1V2M4 and her blood tests revealed an increased ammonia level of 299μg/dl. Brain CT and MRI, as well as cerebrospinal fluid examination demonstrated normal findings. The patient was subsequently diagnosed with a urinary tract infection with urease-producing bacteria, following which we intubated, and catheterized the bladder, and administered ampicillin/sulbactam. Six hours after admission, the blood level of ammonia decreased to 58μg/dl. The next day, the patient's consciousness level improved to GCS E4VTM6. Urine culture showed Corynebacterium urealyticum with urease-producing activity. <Case 2> A 67-year-old woman with disturbance of consciousness was admitted under emergency. Her consciousness level was GCS E1V2M4 and her blood tests revealed an increased ammonia level of 343μg/dl. Subsequently, we diagnosed the patients with urinary tract infection with urease-producing bacteria, and catheterized the bladder, following which cefozopran was administered. Six hours after admission, the blood level of ammonia decreased to 47μg/dl. Urine culture showed Klebsiella oxytoca with urease-producing activity. Both cases demonstrated, urinary retention with neurogenic bladder. Urinary tract infection by urease-producing bacteria must be considering in cases hyperammonemia with urinary retention.
