Late in your shift, you evaluate a 26-year-old woman who has a confirmed intrauterine pregnancy at 11 weeks? gestation and presents for fever, dysuria, and right flank pain. An ultrasound was performed in triage that showed bilateral mild hydronephrosis.
Several questions flood your mind. What do you make of that finding, which antibiotics would be safe for treatment, and can she be managed as an outpatient?
You diagnosed your patient with pyelonephritis. Since there are not good data supporting routine outpatient management of pyelonephritis in pregnancy, you consulted her obstetrician to discuss admission. She received ceftriaxone 1 g IV, was admitted to the hospital, and recovered uneventfully. The hydronephrosis was symmetric and bilateral, which is typical during pregnancy, so no further workup for this was undertaken. She was discharged on cephalexin after sensitivities resulted.