Pyelonephritis / UTI
Pyelonephritis / UTI
Stable vital signs
Lactate < 2.5 (after hydration at time of admission)
Urinalysis and presenting symptoms consistent with urinary tract infection
Urine cultures sent
Normal mental status
Altered mental status
Signs of severe sepsis
Unstable vital signs
Immunocompromised patients (HIV, transplant patients, chronic high dose steroids, asplenic)
Critical or abnormal labs
Chronic Foley catheter
Solitary kidney
Infected kidney stone – clinically or radiographically
Labs
CBC, BMP, Urine cultures if not done in ED
Blood cultures per hospital protocol
Medication
IV Antibiotics: Ceftriaxone 1gm IV q24 hours OR Levaquin 500mg IV q24 hours
IV fluids
Analgesics prn
Antiemetics prn
Imaging
If not obtained in ED, consider CT of abdomen/pelvis without contrast or ultrasound if persistent symptoms, fever or worsening flank pain
Consults
Consider Urology consult if male patient
Disposition
Improving of symptoms (pain control, tolerating PO fluids)
Ability to take oral medications
Stable vital signs
Follow up established
Clinical deterioration or lack of improvement
Inability to tolerate oral intake
Unstable vital signs or evidence of severe sepsis
Worsening renal function