1) An 18-year old woman presents with urinary frequency,

dysuria, and low-grade fever. Urinalysis shows pyuria and bacilli.

She has never had similar symptoms or treatment for urinary
tract infection.
a) What category of UTI does this patient have?
b) Does this patient require further testing?
c) Would you treat this patient, and if so, with what and how
long?

a) Acute & Uncomplicated UTI by E. coli

b) No - Dipstick urinalysis (no culture or lab tests needed)
c) Bactrim (is a combination of two antibiotics: sulfamethoxazole
and trimethoprim) x 3 days - Nitrofurantoin x 7 days

– Burning pain accompanying urination (dysuria)

– Pyuria: the presence of pus in the urine, typically from
bacterial infection.
A bacillus, or bacilliform bacterium, is a rod-shaped bacterium or
archaeon. Bacilli are found in many different taxonomic groups of
bacteria.
2) An 18-year old woman present with her third episode of
urinary frequency, dysuria, and pyuria in the past 4 months.
a) What further questions do you have for this patient?
b) What type of UTI does this patient have?
c) What testing might you perform in this patient?
d) How would you treat her, and for how long?

a) recurrancy, medications, urination frequency- in small amounts,

frequent sexual intercourse
b) Recurrent UTI - Recurrent Cystitis
c) Urine Culture, STD testing, Refer to Urology, U/S
d) 7-14 days, Self admin or Prophylaxis, PO Cipro or Levofloxacin,
clean the genital areas before and after sex and to wipe from front to
back, Nitrofurantoin or amoxicillin/clavulanic

Diagnosis: Dipstick analysis, Urine culture

3) A 24-year old woman presents with fever, chills, nausea,
vomiting, flank pain and tenderness. Her temperature is 40°C,
pulse rate is 120/min., and blood pressure is 100/60 mm Hg.

a) What further studies do you want in this patient?

b) How would you treat this patient?
c) What might you do if she does not improve after 3-4 days?

Pyelonephritis: Upper urinary tract Infection

 Diagnosis: physical exam - CVA tenderness, Labs: Urinalysis
+ leukocyte esterase
+ nitrites
 More likely gram-negative rods
+ WBCs
+ RBCs

a) Blood culture, CBC, CMP, Urinalysis, urine culture, Chemistry

CMP test: The comprehensive metabolic panel (CMP) is a blood test

that gives doctors information about the body's fluid balance, levels of
electrolytes like sodium and potassium, and how well the kidneys and
liver are working.

b) 2-weeks of Trimethroprim/sulfamethoxazole (Bactrim) or

fluoroquinolone

Treatment
usually E coli or other Enterobacteriaceae. Accepta ble regimens may include
fluoroquinolones, cephalosporins, penicillins, extended-spectrum penicillins,
carbapenems, and aminoglycosides.

If enterococci are suggested on the basis of Gram stain results, ampicillin or

vancomycin can replace the fluoroquinolone.
c) Hospitalization and IV antibiotics. IV therapy should be given
for 24-48 hours or until severe symptoms improve.

Complications:
 Perinephric/Renal abscess:
o Suspect in patient who is not improving on antibiotic therapy.
o Diagnosis: CT with contrast, renal ultrasound
o May need surgical drainage.
 Nephrolithiasis with UTI
o Suspect in patient with severe flank pain
o Need urology consult for treatment of kidney stone