Urgent Care For UTI 2 — Questions and Answers
Question 1: A 28-year-old woman presents with dysuria and frequency for 2 days. Urinalysis shows positive nitrites and leukocyte esterase. She has no fever or flank pain. What is the most appropriate next step?
- Order urine culture and await results before treating
- Prescribe nitrofurantoin 100 mg twice daily for 5 days (Correct answer)
- Prescribe ciprofloxacin 500 mg twice daily for 7 days
- Refer to urology for cystoscopy
Correct answer: Prescribe nitrofurantoin 100 mg twice daily for 5 days
Nitrofurantoin for 5 days is first-line therapy for uncomplicated UTI in non-pregnant women per current IDSA guidelines.
Question 2: Which organism is responsible for the majority of uncomplicated UTIs in outpatient settings?
- Klebsiella pneumoniae
- Proteus mirabilis
- Escherichia coli (Correct answer)
- Staphylococcus saprophyticus
Correct answer: Escherichia coli
E. coli accounts for approximately 80–85% of uncomplicated UTIs in community settings.
Question 3: A 65-year-old man with an indwelling urinary catheter has a UA with bacteriuria but no symptoms. What is the recommended management?
- Treat with a 7-day course of trimethoprim-sulfamethoxazole
- Remove the catheter and recheck UA in 48 hours
- No antibiotic treatment; asymptomatic bacteriuria in catheterized patients does not require treatment (Correct answer)
- Send urine culture and treat based on sensitivities
Correct answer: No antibiotic treatment; asymptomatic bacteriuria in catheterized patients does not require treatment
Asymptomatic bacteriuria in catheterized patients should not be treated with antibiotics as treatment does not improve outcomes and promotes resistance.
Question 4: A pregnant woman at 16 weeks gestation has a urine culture growing >100,000 CFU/mL of E. coli. She has no symptoms. What is the correct management?
- Reassure and repeat culture at 28 weeks
- Treat with antibiotics, as asymptomatic bacteriuria in pregnancy requires treatment (Correct answer)
- Prescribe nitrofurantoin 100 mg twice daily for 5 days only in the third trimester
- No treatment is needed since she has no symptoms
Correct answer: Treat with antibiotics, as asymptomatic bacteriuria in pregnancy requires treatment
Asymptomatic bacteriuria in pregnancy must be treated to prevent progression to pyelonephritis and adverse pregnancy outcomes.
Question 5: A 35-year-old diabetic woman presents with 3 days of dysuria, left flank pain, fever of 38.9°C, and costovertebral angle tenderness. What diagnosis best fits this picture?
- Uncomplicated cystitis
- Acute pyelonephritis (Correct answer)
- Renal calculus with obstruction
- Ovarian cyst rupture
Correct answer: Acute pyelonephritis
Fever, flank pain, and costovertebral angle tenderness together with urinary symptoms indicate acute pyelonephritis.
Question 6: Which antibiotic is generally avoided in uncomplicated UTI due to high rates of E. coli resistance in the US?
- Nitrofurantoin
- Fosfomycin
- Trimethoprim-sulfamethoxazole (TMP-SMX) (Correct answer)
- Pivmecillinam
Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX)
TMP-SMX resistance among E. coli commonly exceeds 20% in many US regions, making it less reliable as empiric therapy.
Question 7: A 19-year-old sexually active woman presents with dysuria. Pelvic exam is normal, UA shows pyuria without bacteriuria, and cervical swab is pending. What additional pathogen should be considered?
- Candida albicans
- Chlamydia trachomatis (Correct answer)
- Trichomonas vaginalis
- Herpes simplex virus type 2
Correct answer: Chlamydia trachomatis
Chlamydia trachomatis causes urethritis that mimics cystitis, presenting with pyuria but often without bacteriuria on standard UA.
Urgent Care For UTI 2
A 28-year-old woman presents with dysuria and frequency for 2 days.
Urinalysis shows positive nitrites and leukocyte esterase.
She has no fever or flank pain.
What is the most appropriate next step?