Case Reports in Medicine

Case Report

A Case Series of Emphysematous Pyelonephritis

Table 1

Patient laboratory data and antibiotic treatment.


Case/data	Metabolic panel	Blood count	Urine analysis	Antibiotics

Case 1	Na⁺ 125 mEq/L K⁺ 6.6 mEq/L Cl⁻ 87 mEq/L HC 24 mEq/L BUN 23 mg/dL Cr 2.7 mg/dL Glu 917 mg/dL	WBC 12.5 k/mm³ Hgb 14 g/dL Hct 41% Plt 273 k/mm³	Turbid 4+ bacteria >100 WBC >100 RBC 3+ blood 2+ leukocyte esterase Nitrate negative	Empiric Nafcillin 1 g IV q6 followed by Vancomycin 1 g IV q12 for 14-day monotherapy based on susceptibility results

Case 2	Na⁺ 140 mEq/L K⁺ 4.2 mEq/L Cl⁻ 104 mEq/L HC 22 mEq/L BUN 32 mg/dL Cr 2.9 mg/dL Glu 98 mg/dL	WBC 16.8 k/mm³ Hgb 11.5 g/dL Hct 37.6% Plt 271 k/mm³	Turbid 1+ bacteria 20–50 WBC 0 RBC 1+ leukocyte esterase Nitrate positive	Empiric Cefepime 1 g IV q12 followed by Ceftriaxone 1 g IV q24 based on susceptibility results. Thereafter Ciprofloxacin 500 mg po q24 for 10 days based on susceptibility results

Case 3	Na⁺ 143 mEq/L K⁺ 3.6 mEq/L Cl⁻ 109 mEq/L HC 21 mEq/L BUN 21 mg/dL Cr 0.7 mg/dL Glu 98 mg/dL	WBC 17.5 k/mm³ Hgb 13.2 g/dL Hct 41.9% Plt 224 k/mm³	Turbid 4+ bacteria >100 WBC >100 RBC 3+ blood 3+ leukocyte esterase Nitrate negative	Empiric Ciprofloxacin 400 mg IV q12 followed by Bactrim DS po BID for 30 days based on susceptibility results

Case 4	Na⁺ 136 mEq/L K⁺ 4.7 mEq/L Cl⁻ 104 mEq/L HC 24 mEq/L BUN 12 mg/dL Cr 1.2 mg/dL Glu 105 mg/dL	WBC 18.8 k/mm³ Hgb 10.4 g/dL Hct 29.7% Plt 387 k/mm³	Turbid 24+ bacteria 10–20 WBC 5–10 RBC 1+ blood 3+ leukocyte esterase Nitrate positive	Empiric Zosyn 3.3.7 IV q6 and IV Ceftriaxone 2 gm q24 followed by Ciprofloxacin 400 mg IV q12 along with Ceftriaxone 2 gm IV q24 g for a total of 14 days based on susceptibility results

Case 5	Na⁺ 138 mEq/L K⁺ 4.6 mEq/L Cl⁻ 109 mEq/L HC 19 mEq/L BUN 65 mg/dL Cr 6.5 mg/dL Glu 72 mg/dL	WBC 17.3 k/mm³ Hgb 9.7 g/dL Hct 30.3% Plt 293 k/mm³	Not available as patient is a hemodialysis patient	Unasyn 3 g IV q24 and Imipenem 500 mg IV q6 for 14 days