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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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lunes, 28 de septiembre de 2020

Emphysematous Pyelonephritis

emDocs - September 28, 2020 - By Rusnack F 
Reviewed by: Chavez S; Koyfman A; Long B

"Key Points:
  • Suspect EPN in patients with risk factors (DM, immunocompromised, female sex) who present with fever/dysuria/abdominal pain or who do not respond to usual pyelonephritis treatment.
  • CT imaging of the abdomen and pelvis with contrast is the imaging modality of choice to identify gas. KUB or US may be used to aid in early recognition.
  • EPN has a high mortality rate. Start resuscitation measures early including empiric antibiotic therapy such as third-generation cephalosporins with aminoglycosides, fourth-generation cephalosporins, carbapenems, combination beta-lactamase inhibitors, or fluoroquinolones depending on patient risk factors (note: take into account local antibiogram).
  • Consult urology emergently to determine the need for further procedural interventions such as PCD or if severe/nonfunctioning, emergent nephrectomy."