What Is the Initial Treatment of Emphysematous Pyelonephritis?
Emphysematous pyelonephritis (EPN) requires urgent, simultaneous management across multiple fronts. The initial approach is structured as a coordinated resuscitation effort addressing several critical parameters at once — a delay in any one area can affect overall outcome.
Initial Management Priorities
The cornerstone of early EPN management is resuscitation, with a three-pronged approach addressing fluid and hemodynamic status, diabetic control, and antibiotic therapy. Correction of electrolyte and glucose abnormalities is part of this immediate phase. Patients who present in a moribund state may require ventilatory support in addition to standard resuscitation measures.
Treatment — Partial Overview
Antibiotic therapy targets Gram-negative bacteria and is selected in line with local hospital policy — specific agent selection, sequencing, and the remainder of the management algorithm are detailed in the full evidence-based regimen.
Full regimen including agent options, clinical decision points, and treatment sequence available below.
References
DOI: 10.1038/nrurol.2009.51
- The initial management of a patient with EPN is resuscitation; a three-pronged approach should be put into place to address fluid/hemodynamic status, diabetic control and an antibiotic regimen.
- Patients who are moribund at presentation might need ventilatory support.
- Treatment of patients with EPN comprises resuscitation, correction of any electrolyte and glucose problems, and administration of antibiotics targeting Gram-negative bacteria.
- The choice of antibiotic regimen should be appropriate for targeting Gram-negative bacteria, and will be determined by the local hospital policy (and any knowledge of the sensitivity of the organism involved in the infection), but usually includes aminoglycosides, β-lactamase inhibitors, cephalosporins and quinolones.
- Park and colleagues use piperacillin and tazobactam empirically.
- Shokeir et al. and Chan et al. used a cephalosporin together with an aminoglycoside.
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