Complicated URI infection

Case report:

A 72 year old female patient complains of significant pain in the right renal bed, feverish temperatures to 39 � C, malaise, fatigue and nausea. Pain during urination are not reported, the stool was normal, specific travel activities or abnormalities in the family and work history are not specified.
The physical examination a significant knock and pressure pain in the right renal camp, the body temperature is raised at 38 � C measured axillary, the heart rate is around 96 per minute, the blood pressure is 150/90 mmHg.

Diagnosis:

From the history of the patient is known to suffer from recurrent kidney stones with deposit small calculi in the kidneys chalices for many years. A lithotripsy two years ago was only partially successful, small stone remains in the chalice systems could not be removed. Since that time were always in pyelonephritis, requiring repeated antibiotic treatment. In immediately examined urine sediment a significant leucocyturia, moderate hematuresis and also a slight proteinuria is detected. Since it is a complicated UTI with repeated recurrences, midstream urine is taken for bacteriological examination.

Pathogenesis:

The majority of patients with complicated urinary tract infections of the upper concrement in the kidneys are older women. Dominant agents in such infections are Proteus mirabilis, E. coli and often also in mixed infections enterococci. In this patient, there was a significant bacterial count of 106 Proteus mirabilis per ml of urine, with resistance to cotrimoxazole (EUSAPRIM others), but good sensitivity to levofloxacin (Tavanic).

Therapy:

Complicated urinary tract infections should be treated in principle only on the basis of resistance testing. In controlled studies, co-trimoxazole and / or fluoroquinolones have at proven sensitivity proved to be more effective than beta-lactam antibiotics. It is important that adequate tissue levels are achieved in the renal parenchyma. In this case, treatment with 1x500 mg Levofloxacin (Tavanic) is therefore introduced over two weeks. Longer treatment periods over three or four weeks have not produced improved results in controlled trials.