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Septic shock from acute pyelonephritis — SCE Acute Medicine MCQ

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EasyInfectious diseasesSeptic shock from acute pyelonephritisSCE Acute Medicine

A 67-year-old woman presents with fever, rigors and flank pain. Blood pressure is 84/48 mmHg after 500 mL crystalloid, respiratory rate is 30/min, lactate is 5.1 mmol/L and creatinine is 196 micromol/L. Urine dip is positive for nitrites and blood. What is the most appropriate next step in management?

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Correct answer: D — Give immediate broad-spectrum intravenous antibiotics, further fluid resuscitation and senior escalation

She has septic shock most likely from pyelonephritis and needs immediate antibiotics, cultures if this does not delay treatment, fluid resuscitation and escalation for vasopressors if shock persists. Waiting for culture is unsafe in high-risk sepsis. Nitrofurantoin does not treat pyelonephritis or sepsis.

Reference: NICE NG253 suspected sepsis in people 16 and over; NICE NG111 pyelonephritis antimicrobial prescribing