Question of the Week # 19

A 76 year old debilitated man with history of advanced dementia lives in an extended care facility. He has a history of recurrent Urinary tract infections which develop every six months with mild fever, frequency of micturition and urinary incontinence. In the past, his urine cultures revealed E.coli > 100,000 colonies on several occassions.  He has no indwelling Foley catheter and he is only placed on diapers. His vital signs are temperature of 98.6, HR 88, RR 18 and a BP of 130/84.  A nurse practioneer has routinely ordered a urinalysis which revealed positive leucoesterase and nitrite. This was followed by a urine culture that revealed 100,000 colonies of E.coli. The nurse is concerned about this finding and calls you for appropriate management.
What is the appropriate treatment?

A. Cystoscopy and Intra-venos pyelogram
B. Continuous low dose antibiotics for prevention of recurrent UTIs
C. Catheterize and irrigate the Bladder daily
D. Intravenos antibiotics with broad spectrum coverage
E. No need of treatment as this is colonization

Copy Rights: Archer USMLE Reviews

25 Responses

  1. e

  2. D. IV antibiotics with board spectrum coverage

  3. e asymptomatic bacteriuria

  4. recurrent uti needs further workup…cystocsopy nd ivp

  5. A, ‘recurrent Urinary tract infections which develop every six months with mild fever, frequency of micturition and urinary incontinence’ sounds like obstruction & recurrent inf, so need to investigate

  6. its eeeeeeeeeeee

  7. A
    Recurrent UTI should be investigated
    Dr Red , would you please comment?

  8. b

  9. my choice is BB

  10. bbbbb

  11. Answer. E

    Key Concepts : Recognize the definition of “Recurrent” UTI . Recognize the difference between “colonization” and “Active Infection”

    Answer. E No need of treatment is the correct choice because this old man has no signs of active infection at this time. He has no fever or tachycardia or any signs of sepsis or infection.

    Ans. A is incorrect. Cystoscopy and IVP can be performed to evaluate the urinary tract if the patient had severe UTI or recurrent UTI. It is not the appropriate step at this time.

    Ans. B would be appropriate as a prophylactic therapy if the patient has Recurrent UTI. Understand that the Recurrent UTI is defined as 2 or more episodes in past 6 months or 3 or more episodes in past one year. This patient does not meet the criteria of recurrent UTI since he suffers only one episode every 6 months.

    Ans. C is not helpful in preventing UTI and is also, not appropriate step at this time. Indwelling catheters may in fact, increase the risk of UTIs.

    Ans. D would be appropriate if the patient had severe UTI. He has no signs of acute infection at this time.


  13. The answer is B
    No single definition of the frequency of recurrent urinary tract infection (UTI) exists. A pragmatic definition is 3 or more per year.

  14. answer :E

  15. 100,000 colonies is enough to investigate further. its possible that it could be caused by BPH. Do a rectal for bph then treat the underlying cause.

  16. asymptomatic UTI treated in 3 situations:
    1) pregnancy
    2) orthopedic surgery like hip replacement
    3) before urological procedure

  17. sorry I meant asymptomatic colonization, the answer is E

  18. Surely UA positive for leucocyte esterase and nitrite should be taken into condisderation, even if the patient is asymptomatic, and urine culture with >100, 000 organisms. in clinical practice this elderly gentleman probably would be put on a broad spectrum antibiotic.

  19. B

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