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    Subtle Clues that Change Management of UTIs in Women - Study Findings

     

    Try this free Management of UTIs in Women Case Q&A courtesy of Med-Challenger.

    In January 2022, an interesting study was published that discussed the importance of a subtle yet management-altering urinalysis finding in women with a simple urinary tract infection. What is this finding and how does it affect management of UTIs in women?

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    Try this case and test your knowledge of this subtle yet management-altering finding in women with a simple urinary tract infection.

    A 48-year-old woman presents with a complaint of dysuria, frequent urination, urgency, and foul-smelling urine for the last 3 days.

    She denies fever, chills, flank pain, or gross hematuria.

    She has had a hysterectomy for dysplasia and has no other medical history.

    Her clean catch urine shows:

    • specific gravity 1.030
    • urine pH 8.5 
    • bacteria 3+
    • blood 1+
    • glucose negative
    • ketones trace
    • leukocyte esterase 3+
    • nitrite positive 
    • protein 2+

    Microscopy shows many bacteria, <5 squamous epithelial cells/high- power field (HPF); > 2 RBC/HPF RBCs; > 10 WBC/HPF WBC, urobilinogen 1.5 mg/dL, no budding yeast.

    Question:

    Which clue or combination of clues predicts resistance to one of the first line antibiotics recommended by national guidelines for this patient’s urinary tract problem?

    Answer Options:

    Positive urobilinogen is predictive of microbial resistance to ciprofloxacin.

    The combination of high specific gravity and an elevated urobilinogen is predictive of microbial resistance to trimethoprim-sulfamethoxazole.

    Protein spilling in combination with an elevated urobilinogen is predictive of microbial resistance to trimethoprim-sulfamethoxazole.

    Alkaline pH is predictive of microbial resistance to nitrofurantoin.

     

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