From Dr. Johnson – Two NEJM Articles

“I find myself talking of the need to treat sterile pyuria a lot in the ED…”
Sterile Pyuria
Gilbert J. Wise, M.D., and Peter N. Schlegel, M.D.
N Engl J Med 2015; 372:1048-1054March 12, 2015DOI: 10.1056/NEJMra1410052



“…an editorial re a paper on antibiotic care of skin infections…It doesn’t answer all the questions we want answered, but I think the last 3 paragraphs are a reasonable approach…”
Choosing an Antibiotic for Skin Infections
Michael R. Wessels, M.D.
N Engl J Med 2015; 372:1164-1165March 19, 2015DOI: 10.1056/NEJMe1500331

Last three paragraphs:

As noted above, the differential diagnosis of sterile pyuria is broad (FIGURE 1). A complete history and physical examination with consideration of the factors listed in Table 1 are required to identify the potential causes of genitourinary inflammation. Specific evaluation for sexually transmitted infections is warranted. Evaluation to detect bacterial, fungal, and parasitic infections is indicated in patients with a clinical history that suggests specific infections.

Abdominal, renal, and bladder imaging should be considered for evaluation of febrile or otherwise symptomatic patients. Inflammatory conditions near the urinary tract as well as systemic diseases should be included in the differential diagnosis (TABLE 2). Sterile pyuria has historically been considered to be suggestive of genitourinary tuberculosis, but a wide variety of other causes must be considered.

Criteria for successful treatment of conditions that cause sterile pyuria include curtailment or resolution of symptoms, a negative culture, or a negative PCR assay. Pyuria may persist because of underlying inflammatory changes.



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