Pyelonephritis managed by Hospital in the Home

Nina, 33 years, had two days left flank pain, fevers and dysuria. WCC 10.2, normal creatinine and urea, CT KUB showed nil stones, normal kidneys. A diagnosis of uncomplicated pyelonephritis was made, and Dr L commenced her empirically on trimethoprim while awaiting urine culture. No history of UTIs, stones or STIs.

Nina vomited overnight eight times. MSU grew E.Coli x 108 susceptible to all antibiotics tested.

Dr L contacted the RPA Hospital in the Home (HITH) doctor via HealthPathways Sydney, asked for a same day appointment and faxed the patient summary and results, including a βHCG.

Nina went to RPA HITH Level 5 Gloucester House. O/E T 38.9, HR 105, BP 110/72, dry oral mucous membranes, vomiting, left flank tenderness. No other foci of sepsis.

An IV antiemetic, IV normal saline 1L and IV ceftriaxone 1g was given. The HITH staff monitored her for four hours. The recommended antibiotics for unknown urinary sepsis are gentamycin and ampicillin. As she had known urinary sepsis she was given ceftriaxone to minimise her vomiting with multiple antibiotics. Oral paracetamol and ibuprofen for pain relief were also given. Next day Nina had less flank pain and was drinking. Blood culture was negative. She was still moderately dehydrated and had another 1L IV normal saline and a second dose of IV ceftriaxone 1g.

On the third day her left flank pain and fever had resolved, she no longer had dysuria and was drinking and eating. She was given a third dose of IV ceftriaxone 1g, and switched to 10 days of oral amoxycillin/clavulanate 875mg/125mg one tablet, twice daily. Nina was asked to present to her GP for a repeat urine culture two days after her last dose of antibiotics to ensure her infection had fully cleared and a discharge summary was given to her and sent electronically to her GP.

Hospital in the Home services are located at Balmain, Canterbury, Concord and RPA hospitals. Your patient with cellulitis, mastitis or community acquired pneumonia may benefit from HITH assistance if they are not improving or unable to tolerate oral antibiotics.