Pyonephrosis medical therapy: Difference between revisions
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==Medical therapy== | ==Medical therapy== | ||
*Pyonephrosis is a urological emergency.<ref name="pmid27261785">{{cite journal| author=Ludvigson AE, Beaule LT| title=Urologic Emergencies. | journal=Surg Clin North Am | year= 2016 | volume= 96 | issue= 3 | pages= 407-24 | pmid=27261785 | doi=10.1016/j.suc.2016.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27261785 }} </ref> | *Pyonephrosis is a [[urological]] emergency.<ref name="pmid27261785">{{cite journal| author=Ludvigson AE, Beaule LT| title=Urologic Emergencies. | journal=Surg Clin North Am | year= 2016 | volume= 96 | issue= 3 | pages= 407-24 | pmid=27261785 | doi=10.1016/j.suc.2016.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27261785 }} </ref> | ||
*Hemodynamically unstable patients may require aggressive fluid resuscitation with crystalloids and pressor agent (dopamine) to maintain adequate blood pressure. | *[[Hemodynamically unstable]] patients may require aggressive [[fluid resuscitation]] with crystalloids and pressor agent (dopamine) to maintain adequate blood pressure. | ||
*Before initiating antimicrobial treatment for suspected pyonephrosis, urine and blood culture and susceptibility test should always be performed. | *Before initiating antimicrobial treatment for suspected pyonephrosis, urine and blood culture and susceptibility test should always be performed. | ||
*All patients with pyonephrosis should be empirically treated with long-acting, broad-spectrum antibiotics which may be later narrowed based on culture report. | *All patients with pyonephrosis should be empirically treated with [[Intravenous therapy|intravenous]] long-acting, [[Broad-spectrum antibiotics|broad-spectrum]] antibiotics which may be later narrowed based on culture report. | ||
*Presence of pyonephrosis and obstruction reduces the efficacy and penetration of antibiotics. Therefore, drainage of the pus should be done immediately after administering the antibiotics. | *Presence of pyonephrosis and obstruction reduces the efficacy and penetration of antibiotics. Therefore, drainage of the pus should be done immediately after administering the antibiotics. | ||
*Intravenous [[Ampicillin]] + [[Gentamicin]] is a good initial option that covers both gram-positive and negative organisms. | *Intravenous [[Ampicillin]] + [[Gentamicin]] is a good initial option that covers both gram-positive and negative organisms. | ||
*Anaerobic coverage with [[ | *[[Anaerobic organism|Anaerobic]] coverage with [[clindamycin]], [[Antifungals|antifungal]], or [[Tuberculosis medical therapy|antitubercular]] agents may be required depending upon the clinical scenario. | ||
*Carbapenem-resistant enterobacteriaceae can be treated with ceftazidime-avibactam, ceftolozane-tazobactam<ref name="pmid25931244">{{cite journal| author=Wagenlehner FM, Umeh O, Steenbergen J, Yuan G, Darouiche RO| title=Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI). | journal=Lancet | year= 2015 | volume= 385 | issue= 9981 | pages= 1949-56 | pmid=25931244 | doi=10.1016/S0140-6736(14)62220-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25931244 }} </ref>, meropenem-vaborbactam<ref name="pmid30128699">{{cite journal| author=Dhillon S| title=Meropenem/Vaborbactam: A Review in Complicated Urinary Tract Infections. | journal=Drugs | year= 2018 | volume= 78 | issue= 12 | pages= 1259-1270 | pmid=30128699 | doi=10.1007/s40265-018-0966-7 | pmc=6132495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30128699 }} </ref>, and imipenem-cilastatin-relebactam.<ref name="pmid32820669">{{cite journal| author=Kuiper SG, Leegwater E, Wilms EB, van Nieuwkoop C| title=Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections. | journal=Expert Opin Pharmacother | year= 2020 | volume= 21 | issue= 15 | pages= 1805-1811 | pmid=32820669 | doi=10.1080/14656566.2020.1790525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32820669 }} </ref><ref name="pmid31724043">{{cite journal| author=Doi Y| title=Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections. | journal=Clin Infect Dis | year= 2019 | volume= 69 | issue= Suppl 7 | pages= S565-S575 | pmid=31724043 | doi=10.1093/cid/ciz830 | pmc=6853760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31724043 }} </ref> | *[[Carbapenem]]-resistant [[enterobacteriaceae]] can be treated with [[ceftazidime]]-avibactam, ceftolozane-[[tazobactam]]<ref name="pmid25931244">{{cite journal| author=Wagenlehner FM, Umeh O, Steenbergen J, Yuan G, Darouiche RO| title=Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI). | journal=Lancet | year= 2015 | volume= 385 | issue= 9981 | pages= 1949-56 | pmid=25931244 | doi=10.1016/S0140-6736(14)62220-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25931244 }} </ref>, [[Meropenem / vaborbactam (Vabomere)|meropenem-vaborbactam]]<ref name="pmid30128699">{{cite journal| author=Dhillon S| title=Meropenem/Vaborbactam: A Review in Complicated Urinary Tract Infections. | journal=Drugs | year= 2018 | volume= 78 | issue= 12 | pages= 1259-1270 | pmid=30128699 | doi=10.1007/s40265-018-0966-7 | pmc=6132495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30128699 }} </ref>, and [[imipenem]]-[[cilastatin]]-relebactam.<ref name="pmid32820669">{{cite journal| author=Kuiper SG, Leegwater E, Wilms EB, van Nieuwkoop C| title=Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections. | journal=Expert Opin Pharmacother | year= 2020 | volume= 21 | issue= 15 | pages= 1805-1811 | pmid=32820669 | doi=10.1080/14656566.2020.1790525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32820669 }} </ref><ref name="pmid31724043">{{cite journal| author=Doi Y| title=Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections. | journal=Clin Infect Dis | year= 2019 | volume= 69 | issue= Suppl 7 | pages= S565-S575 | pmid=31724043 | doi=10.1093/cid/ciz830 | pmc=6853760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31724043 }} </ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Harsh Vardhan Chawla, M.B.B.S.[2]
Medical therapy
- Pyonephrosis is a urological emergency.[1]
- Hemodynamically unstable patients may require aggressive fluid resuscitation with crystalloids and pressor agent (dopamine) to maintain adequate blood pressure.
- Before initiating antimicrobial treatment for suspected pyonephrosis, urine and blood culture and susceptibility test should always be performed.
- All patients with pyonephrosis should be empirically treated with intravenous long-acting, broad-spectrum antibiotics which may be later narrowed based on culture report.
- Presence of pyonephrosis and obstruction reduces the efficacy and penetration of antibiotics. Therefore, drainage of the pus should be done immediately after administering the antibiotics.
- Intravenous Ampicillin + Gentamicin is a good initial option that covers both gram-positive and negative organisms.
- Anaerobic coverage with clindamycin, antifungal, or antitubercular agents may be required depending upon the clinical scenario.
- Carbapenem-resistant enterobacteriaceae can be treated with ceftazidime-avibactam, ceftolozane-tazobactam[2], meropenem-vaborbactam[3], and imipenem-cilastatin-relebactam.[4][5]
References
- ↑ Ludvigson AE, Beaule LT (2016). "Urologic Emergencies". Surg Clin North Am. 96 (3): 407–24. doi:10.1016/j.suc.2016.02.001. PMID 27261785.
- ↑ Wagenlehner FM, Umeh O, Steenbergen J, Yuan G, Darouiche RO (2015). "Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI)". Lancet. 385 (9981): 1949–56. doi:10.1016/S0140-6736(14)62220-0. PMID 25931244.
- ↑ Dhillon S (2018). "Meropenem/Vaborbactam: A Review in Complicated Urinary Tract Infections". Drugs. 78 (12): 1259–1270. doi:10.1007/s40265-018-0966-7. PMC 6132495. PMID 30128699.
- ↑ Kuiper SG, Leegwater E, Wilms EB, van Nieuwkoop C (2020). "Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections". Expert Opin Pharmacother. 21 (15): 1805–1811. doi:10.1080/14656566.2020.1790525. PMID 32820669 Check
|pmid=value (help). - ↑ Doi Y (2019). "Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections". Clin Infect Dis. 69 (Suppl 7): S565–S575. doi:10.1093/cid/ciz830. PMC 6853760 Check
|pmc=value (help). PMID 31724043.