Case Report 21/10/2009 David Tran A&E department FVHospital

Mr MKH, 58 years old, consult in FVH clinic on oct. 21th  No past medical history  He complains mild fever for 2 days  No sore throat, no cough  Physical examination without abnormalities What are your investigations ?

Results of blood test (1)

Results of the blood test (2)

Results of the urine test What is your diagnosis ?

Conclusion  Urinary tract infection  Benign prostatic hypertrophy What is your prescription?

Prescription

Review in A&E 2 days later (23/10)  Still headache and mild fever (but 37.6)  Abdomen supple no abdominal or back pain  He complains decreased mild dysuria Diagnosis: J3 urine infection (pyelonephritis or prostatitis) treated with Bactrim since yesterday. No fever this after noon no signs of severeness (no lombal pain, no chill, no fever) > carry on the treatment and review urologist in 48h (with the result of the ECBU) ; He has to come earlier if high fever or chills.

Review by urologist 2 days later (Oct. 25 th )  No fever  Mild dysuria 26/10/2009 : IU avec fievre + dysurie et BM BU : leuco et nitrite (+) Deja eu Bactrim CAT: continuer Bactrim puis RDV ds 2 semaines

ECBU du 23/10/09

Antibiogramme

What is your decision concerning the treatment?  The patient signals allergy to Augmentin® (rash after taking Augmentin® 6 month ago for pharyngitis)  He wants to be treated at home  Without any injection if possible

Prescription after 1 week of Bactrim

 Age > 65 years old  Pregnancy  Sex: male  Urine tract abnormality (Stones, tumor, reflux etc)  Recent surgical or endoscopic procedure on the urine tract  Comorbid diseases (diabetes, renal failure, immunodeficiency) Risk factors for urine infection

Male Urine Infection  All urine infection for a male patient is to be considered as a acute prostatitis.  Prostatitis has to be considered as complicated urine tract infection.  ECBU systematic (70% E. Coli > antibiogramme essential)  Hemocultures x 2 if fever or chills  Echography systematic (abces, stones?)

Rules of treatment for acute prostatitis  Cephalosporine 3 rd generation i.v. or i.m.( Ceftriaxone = OFRAMAX®)  Alternative: Fluoroquinolone by mouth (but > 30% resistance of E.Coli but good prostatic diffusion)  BACTRIM can only be used to take over from 1 st treatment (after antibiogramme > resistance 20 to 40% but good prostatic diffusion)  Avoid AUGMENTIN (30% Coli. Resistant and worst prostatic diffusion)  Duration of treatment 2 weeks (simple) to 3 weeks (complicated)

ECBU infection’s criteria  BU: Leuco & Nitrites negative = VPN 100%  ECBU: Leucocyturia > 10 4 /ml (VPP 46%,VPN 97%)  Bacteriuria +: single colony > 10 5 /ml Bacteriuria /ml Single colony >10 5 /ml Single colony /ml Several colonies >10 5 /ml Several colonies Leuco< 10 4 /mlrecheck ECBU Infection (beginning) Souillure (recheck ECBU) Souillure or infection Leuco> 10 4 /ml Infection, Prostatitis, Antiobio. Infection Souillure or infection (recheck ECBU) Probable Infection