A 20-year old female presented with low back pain but no relief from NSAIDs. She later developed fever along with the back pain. Tests found elevated white blood cells and bacteria in her urine. A urine culture identified Klebsiella Aeroginosa bacteria at 50,000 colonies. An ultrasound found fullness in her renal pelvis, indicating a urinary tract infection that had spread from her bladder to her kidneys. She was prescribed antibiotics but due to a mistake, amikacin was advised instead of the correct antibiotic. She will follow up with an OB/GYN for a second opinion on treatment and continue other medications.

1. Case Presentation
Dr. Richin Koshy

2. Asymptomatic UTI
• 20 yr old female came with complaints of lower
back pain, acute in onset
• No h/o of trauma/strenous exercise
• r/o Appendicitis/ovarian torsion/ectopic
pregnancy/Dysmenorrhea
• D/D – Musculoskeletal Sprain
• Advised – NSAIDS

3. Visited after 2 days with the same complaints no relief
Advised NSAIDS
2 Days later comes up with fever along with low back pain
ADV – CBC/ESR
Follow up with reports – Neutrophils and ESR up
• Again Advised Urine R/E , Urine C/S, USG
• Pus cells up, Klebsiella Aeroginosa 50,000 colonies
• USG – Fullness of Renal Pelvis
• Urine C/S – Sensitivity to Amikacin and Netilimicin
• Intermediate sensitivity to – Ciprofloxacin

4. Examination and Diagnosis
• UTI is caused by many types of bacteria, the most common of which are gram negative
*Escherichia coli*.
• Symptoms of UTI include dysuria (painful urination), increased frequency of urination,
and occasionally hematuria (blood in the urine).
Klebsiella pneumoniae urinary tract infection (UTI) is uncommon compared to other
bacterial UTIs, but it is particularly associated with use of urinary catheters. K.
pneumoniae can cause upper or lower urinary tract inflammation – cystitis, pyelonephritis,
and renal abscesses. It is generally indistinguishable from other UTIs.

5. Treatment given
• Tab Norflox 400 mg BD
• Tab Rantac 150 mg BD
• Made a mistake advising Tab Amikacin due to a ignorant mix up
• Called up immediately for follow up for further plan in management
• Will be following up with OBS/GYN for second opinion regarding Amikacin
• Advised Citalin for further management