URINARY TRACT INFECTION(S)-PYELONEPHRITIS Flashcards
Infectious inflammatory disease involving the kidney parenchyma and renal
pelvis
Pyelonephritis
most common causative agents
Gram-negative bacteria, including:
(a) E coli,
(b) Proteus,
(c) Klebsiella,
(d) Enterobacter,
(e) Pseudomonas.
two less commonly seen causative agents
(a) Enterococcus faecalis
(b) Staphylococcus aureus
Route of infection of pyelonephritis
usually ascends from the lower urinary tract-
(a) Exception of S aureus, which usually is spread by a hematogenous route (blood stream)
Signs and symptoms**
(a) Fever
(b) Flank pain
(c) FUD
(d) Shaking chills
(e) NVD
(g) Tachycardia
(h) CVA tenderness
Differential Diagnosis
(a) Acute cystitis or a lower urinary source
(b) Acute intra-abdominal disease
1) Appendicitis
2) Cholecystitis
3) Pancreatitis
4) Diverticulitis
(c) In males
1) Epididymitis
2) Acute prostatitis
(d) Lower lobe pneumonia
(7)Laboratory Findings
(a) Complete blood cell count
(b) Urinalysis
(c) Urine culture
(d) Blood culture may also be positive.
Imaging
Renal Ultrasound
Treatment
1) Inpatient (severe illness, risk for complicated disease)
a) Ampicillin
2) Outpatient
a) Ciprofloxacin (Cipro),
b) Levofloxaci
c) Phenazopyridine (Pyridium)
Complications
(a) Sepsis and shock can occur.
(b) Inadequate therapy could result in abscess formation.
(c) Catheter drainage may be necessary if urinary retention exists
Follow up
(a) Prompt diagnosis and appropriate treatment, acute pyelonephritis carries a good prognosis
(b) Follow-up urine cultures following the completion of treatment is ideal
(c) MEDEVAC (urology or infectious diseases)
1) Evidence of complicating factors
a) Urolithiasis
b) Obstruction
2) Severe infections or complicating factors
3) Evidence of sepsis
4) Need for parenteral antibiotics
5) Absence of clinical improvement in 48 hours with oral antibiotics.
6) Need for radiographic imaging
7) Need for drainage of urinary tract obstruction
