Pyelonephritis - AMS

Question 1

What organism is responsible for the infection that is the most common etiologic cause of pyelonephritis?

Answer 1

Escherichia coli

Question 2

Who are more likely to be hospitalized with pyelonephritis, males or females? Who has a higher mortality rate?

Answer 2

Females 5x more likely to be hospitalized, but also have a lower mortality rate than men.

Question 3

Where is a pyelonephritic infection localized with the renal anatomy?

Answer 3

Renal parenchyma and pelvis

Question 4

Why is E. coli less commonly the source of pyelonephritis in elderly patients?

Answer 4

The increased use of catheters and instruments predisposes them to infections with other gram-negative organisms. (Proteus, Klebsiella, Serratia, Pseudomonas)

Question 5

Why is acute pyelonephritis considered complicated in men?

Answer 5

Men have a higher probability of urinary tract abnormalities

Question 6

What are S/S of pyelonephritis?

Answer 6

• Fever/chills/nausea/vomiting
• CVA tenderness
• Symptoms suggestive of cystitis may also be present

Question 7

What tests would be used to detect pyuria in a patient suspected to have pyelonephritis?

Answer 7

-Leukocyte esterase test or nitrite test

Question 8

What type of casts would be seen in a U/A of a patient with pyelonephritis?

Answer 8

WBC casts (& WBC)

Question 9

What is the treatment plan for a patient with pyelonephritis?

Answer 9

• Supportive care with fluids and antipyretics
• Antibiotic therapy (PO TMP-SMX DS or Cipro 500 mg PO b.i.d x 10 days)
• IV antibiotics for more toxic patients
• Tx for at least 14 days then re-culture