For Empyema and Pyelonephritis...

[shivasHeroLike]

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for what sounds like empyema: fever, cough+foul smelling sputum, air/fluid level on CXR... is the next step IV Abx or thoracostomy to drain it?

also for what sounds like pyelonephritis: fever, CVA tenderness, etc.. is the next step IV abx or U/S of kidneys?

thanks

 

[Bonesaw45]

for empyema i would say antibiotics first because the thoracostomy is a surgical procedure, thus you'll want the antibiotic coverage to prevent further infection HOWEVER thoracocentesis should probably be done first because its diagnostic and there is the slight chance that antibiotics could effect the yield, but it dosen't matter if you already have a diagnosis of empyema. The big point for empyema is that antibiotics alone won't cure it and eventually you need to drain them whether its a tube acutely or pleural debridement later. Its like an abscess.

for pyelo it should always be Blood Cultures --> Antibiotics + Septic Stabilization then worry about imaging because most of it is clinical diagnosis, US would probably only be helpful if there is a chronic history of pyelo or if there is difficulty resolving because of a suspected renal papillary necrosis or renal abscess but after the steps above.

definitely sure on pyelo, not 100% on empyema

 

[Captopril]

Empyema = abscess, therefore always drain. I know that UW makes it abundantly obvious that it's an abscess, going out of their way to imply there is a capsule, etc.

As for pyelonephritis, as Bonesaw said: blood cx-->Abx. The only time you really image for PN is if there is a history of recurrence, which raises suspicion for a structural cause for the infections.

for what sounds like empyema: fever, cough+foul smelling sputum, air/fluid level on CXR... is the next step IV Abx or thoracostomy to drain it?

also for what sounds like pyelonephritis: fever, CVA tenderness, etc.. is the next step IV abx or U/S of kidneys?

thanks

 

[OveractiveBrain]

for what sounds like empyema: fever, cough+foul smelling sputum, air/fluid level on CXR... is the next step IV Abx or thoracostomy to drain it?

also for what sounds like pyelonephritis: fever, CVA tenderness, etc.. is the next step IV abx or U/S of kidneys?

thanks

Bonesaw had it right, i want to reiterate, to make sure nothing is lost...

UTI: 3 days PO abx

Pyelo: 14 days of PO abx / IV inpatient

if fever persists, or leukocytosis worsens...

Abscess: U/S or CT kidneys (you should not have to choose, unless girl is pregnant).
Abscess is considered when there is reucrrence OR when the Pyelo does not improve.

point is, abx ALWAYS before imaging in pyelo.