title: Diagnosing a common kidney infection of the elderly inpatient.
abstract: Initial antibiotic therapy should be based on Gram's stained urine. For the elderly patient with acute symptomatic bacterial pyelonephritis caused by gram-negative aerobic bacilli, an aminoglycoside is recommended, eg, gentamicin, tobramycin, or amikacin. Pathologic pyuria (greater than 10 WBC/high-power field) supports the clinical impression of acute symptomatic bacterial pyelonephritis. However, many factors can spuriously lower the number of bacteria in the urine: prior diuresis or antimicrobials; obstruction distal to the site of infection; and infection not directly accessible to the collecting system.
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000919:Antibody-Coated Bacteria Test, Urinary; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005188:False Negative Reactions; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D011704:Pyelonephritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D018805:Sepsis / Q000150:complications / Q000382:microbiology; D014031:Tobramycin / Q000627:therapeutic use; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014031:Tobramycin