GIM Question 31 Instructor

A patient on your ward complains of lower abdominal pain, urinary frequency and dysuria.

  1. Outline your next steps.
    This patient is displaying signs and symptoms of an uncomplicated cystitis (female patient, GFR >60). Initial assessment should involve the following:

    • History
      • Symptom onset
      • Past medical history of UTIs
      • Associated nausea/vomiting, fever, hematuria
    • Physical exam
      • Vitals – HR, BP, temperature, RR, SpO2
      • Abdominal exam + CV tenderness
    • Investigations
      • CBC, lytes, Cr, BUN
      • Urine C&S, microscopy, urinalysis
  2. Your patient has a temperature of 390C and you highly suspect a Urinary tract infection. What pathogens do you suspect may be causing her UTI?
    The most common pathogens implicated in UTIs are Escherichia coli (most common), Klebsiella, Enterococcus species, Proteus, and Staphylococcus saprophyticus.
  3. What is your initial, empiric therapy?
    Empiric therapy for an uncomplicated UTI typically includes any one of the following:

    • Nitrofurantoin (macrobid) 100mg PO bid x 3-5d (can only be used in uncomplicated cystitis)
    • Septra 1tab PO BID x3d
    • Ciprofloxacin 500mg PO x3d
    • Clavulin 875mg PO BID x5-7d

    Once the urine c&s returns, treatment should be tailored to the specific pathogen.
    Complicated cystitis involves any male patient, females with a GFR<60, renal transplant patients, and patients with a solitary kidney.
    In the case of a renal transplant patient, nephrology should be consulted for the management of a UTI.

Gupta K et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011, 52:e103-120. doi: 10.1093/cid/ciq257.

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