#EMConf: Pyelonephritis Management Pearls

Discharge:

  • Healthy + young females + tolerating PO + well appearing
  • Admit anyone else
  • Pregnancy gets admitted for increased risk for preterm labor.¬†

Should you send blood culture if admit?

  • about 30% of patients will have positive blood culture but 97% will grow the same bug in urine as in blood therefore¬†urine culture is adequate
  • send blood culture if patient is septic¬†or concerned for renal abscess

When should you think about renal abscess?

  • failing outpatient or inpatient therapy for pyelonephritis
  • consider this for diabetics who are at highest risk for this and for emphysematous pyelonephritis (necrotizing infection of kidney that is rapidly progressive with a 20% mortality)