Monday, January 22, 2018
A 26 year-old woman complains of left flank pain and fever for 2 days. She has a history of two episodes of urinary tract infections in the past three years treated with trimethoprim-sulfamethoxazole. She is married, sexually active and takes contraceptive pills. Her last menstrual period was 5 days ago. On physical examination, her pulse is 100/min., blood pressure is 120/80 and her temperature is 103 F. She has left costovertebral angle tenderness on palpation.
What is the best next step of management?
A-Admission to the intensive care unit (ICU)
B-Collection of urine and blood cultures
C-CT scan of abdomen and pelvis
D-MRI of the kidney
E-Administration of wide spectrum antibiotics
This patient history and clinical examination are consistent with acute pyelonephritis. In this case we should collect urine and blood samples for culture before we start empiric antibiotic treatment. Culture is important for prescribing the most effective antibiotic and for the follow up. The patient is stable and so there is no need for the ICU. Diagnosis of acute pyelonephritis can be reached by history and physical examination only. Imaging studies are not necessary in this case as it is straight forward. In case failure of medical treatment, imaging studies should be considered for further knowledge. Collection of urine and blood samples for culture should be done before administration of any antibiotics to achieve accurate results.
The correct answer is B