Subtle Clues that Change Management of Urinary Tract Infections in Women – Study Findings

Andrea Eberly, MD, MS, FAAEMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Medical News, Nurse Practitioner, Nursing RN/PN, Physician Assistant, Urgent Care

Subtle Clues that Change Management of Urinary Tract Infections in Women - Study Findings

Subtle Clues that Change Management of Urinary Tract Infections in Women - Study Findings Q&A Case

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.

See the Answer:

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